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eLearning Application

Goodwill offers FREE online classes to help enhance your work and life skills. Please fill in the boxes below, indicate the course(s) you’d like to take, and we’ll get you enrolled. All information you provide will be kept strictly confidential.

*Please Read*
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1. Please type in your last name and first name

Please type in your last name and first name Last Name
First Name

2. Fill In The Blanks

Fill In The Blanks Address
City
State
Zip Code
County
email Address
Phone Number
Do you prefer to be contacted by email or phone?
Birthdate
Gender

3. Ethnicity

Ethnicity African American Asian Caucasian	Hispanic Multi-Racial Native American
Other (please specify)

4. Referral Source - How Did You Hear About Our eLearning Classes?

Referral Source - How Did You Hear About Our eLearning Classes? Newspaper Ad Radio Advertisement Brochure/Flier Bus Advertisement Goodwill Website Facebook Online/Google Search	Family/Friend Word of Mouth Staffing Agency Workforce Network Service Provider Department of Corrections DHS/TANF	Mental Health Agency ORS Social Security Veterans Organization IDES (Employment Office) Experience Works Public School
Other (please specify)

5. Education Level

Education Level Elementary Only

Some High School

High School Diploma

GED

Trade School

Some College

Associates Degree

Bachelors Degree

Masters Degree

6. Disability

Disability AIDS Arthritis/Rheumatic Cerebral Palsy Circulatory Disability Disadvantaged	Epilepsy/Seizure Hearing Impairment Learning Disability Mental Illness Multiple	Orthopedic/Mobility Neurological Disability Traumatic Brain Injury Visual Impairment PTSD
Other (please specify)

7. Please answer "Yes" or "No"

Please answer "Yes" or "No" Are you a veteran?
Do you have a history of substance abuse?
Do you have a criminal history?

8. Greatest Disadvantaging Condition

Greatest Disadvantaging Condition Advanced Age

Dislocated Worker

Ex-Offender

Limited Education/Training

Medical Issues

Transportation

Homeless

Immigrant

Other (please specify)

9. Which course(s) would you like to take?

Which course(s) would you like to take? Communication - Business Writing Communication - Telephone Essentials Communication - Business Grammar Communication - Interpersonal Communication Communication - Workplace Conflict Communication - Working With Difficult People Communication - Cross Cultural Communication Communication - Listening Essentials Communication - Anger Management Communication - Basic Presentation Skills Communication - Communicating With Diplomacy & tact Customer Service - Call Center Skills Customer Service - Call Center Management Customer Service - Customer Service Rep Skills Customer Service - Customer Service Fundamentals Customer Service - Customer Focus Customer Service - Customer Advocacy Personal Development - Optimizing Work/Life Balance	Personal Development - Diversity on the Job Personal Development - Effective Time Management Personal Development - Problem Solving and Decision-Making Strategies Personal Development - Critical Thinking Skills Personal Development - Building and Maintaining Trust Personal Development - Personal Productivity Improvement Personal Development - Business Ethics Personal Development - Public Speaking Strategies Personal Development - Performance Under Pressure Personal Development - Doing Business Professionally Computer Basics - Apple Computer Basics - Digital Lifestyle Computer Basics - Google Computer Basics - Internet Basics Computer Basics - Mobile Apps Computer Basics - Social Media Computer Basics - Email Basics Computer Basics - Windows	Computer Basics - Windows Live Microsoft - Outlook (2000,2003,2007,2010) Microsoft - PowerPoint (2000,2003,2007,2010) Microsoft - Publisher (2000,2003,2007,2010) Microsoft - Word (2000,2003,2007,2010) Microsoft - Excel (2000,2003,2007,2010) Microsoft - Access (2000,2003,2007,2010) Office 2000 Office 2003 Office 2007 Everyday Life - Money Everyday Life - Banking Everyday Life - Math Everyday Life - Reading Everyday Life - Life Skills iPad
Other (please specify)

10. Please rate your current level of computer skills/knowledge

	No Skills	Some Skills	Basic Skills	Average Skills	Advanced Skills
Typing/Keyboarding Knowledge/Skills	*Please rate your current level of computer skills/knowledge Typing/Keyboarding Knowledge/Skills No Skills	Typing/Keyboarding Knowledge/Skills Some Skills	Typing/Keyboarding Knowledge/Skills Basic Skills	Typing/Keyboarding Knowledge/Skills Average Skills	Typing/Keyboarding Knowledge/Skills Advanced Skills
Internet Browsing/Using Knowledge/Skills	Internet Browsing/Using Knowledge/Skills No Skills	Internet Browsing/Using Knowledge/Skills Some Skills	Internet Browsing/Using Knowledge/Skills Basic Skills	Internet Browsing/Using Knowledge/Skills Average Skills	Internet Browsing/Using Knowledge/Skills Advanced Skills
eMail Knowledge/Skills	eMail Knowledge/Skills No Skills	eMail Knowledge/Skills Some Skills	eMail Knowledge/Skills Basic Skills	eMail Knowledge/Skills Average Skills	eMail Knowledge/Skills Advanced Skills
Microsoft Word Knowledge/Skills	Microsoft Word Knowledge/Skills No Skills	Microsoft Word Knowledge/Skills Some Skills	Microsoft Word Knowledge/Skills Basic Skills	Microsoft Word Knowledge/Skills Average Skills	Microsoft Word Knowledge/Skills Advanced Skills
Microsoft Excel Knowledge/Skills	Microsoft Excel Knowledge/Skills No Skills	Microsoft Excel Knowledge/Skills Some Skills	Microsoft Excel Knowledge/Skills Basic Skills	Microsoft Excel Knowledge/Skills Average Skills	Microsoft Excel Knowledge/Skills Advanced Skills
Microsoft PowerPoint Knowledge/Skills	Microsoft PowerPoint Knowledge/Skills No Skills	Microsoft PowerPoint Knowledge/Skills Some Skills	Microsoft PowerPoint Knowledge/Skills Basic Skills	Microsoft PowerPoint Knowledge/Skills Average Skills	Microsoft PowerPoint Knowledge/Skills Advanced Skills
Microsoft Access Knowledge/Skills	Microsoft Access Knowledge/Skills No Skills	Microsoft Access Knowledge/Skills Some Skills	Microsoft Access Knowledge/Skills Basic Skills	Microsoft Access Knowledge/Skills Average Skills	Microsoft Access Knowledge/Skills Advanced Skills
Microsoft Publisher Knowledge/Skills	Microsoft Publisher Knowledge/Skills No Skills	Microsoft Publisher Knowledge/Skills Some Skills	Microsoft Publisher Knowledge/Skills Basic Skills	Microsoft Publisher Knowledge/Skills Average Skills	Microsoft Publisher Knowledge/Skills Advanced Skills

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