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English Survey
Please complete this survey, as your responses will help us understand the services you need.
Please complete only one form per household and provide as much information as possible.
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1.
First Name
(Required.)
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2.
Last Name
(Required.)
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3.
Email (If you don’t have an email please type: x)*
(Required.)
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4.
Phone Number
(Required.)
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5.
What is your address: Street, City, NY
(Required.)
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6.
When did you arrive in the United States? Example: 12/31/2005
(Required.)
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7.
What is your current immigration status?
If you are a UHP and arrived after September 30th, 2023, we will contact you as soon as we hear from the Office of Refugee Resettlement regarding the approval of your immigration status. If someone in your immediate family arrived before that date, you are eligible.
(Required.)
DT Parolee (Cuban, Haitian, Nicaraguan, and Venezuelan)
Ukrainian Humanitarian Parolee
UHP
Refugee (REF)
Asylee (ASY)
Victim of Human Trafficking (VOT)
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8.
What is your English level? (chose one)
(Required.)
Minimal
Good
Fluent
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9.
What is your native language/preferred language?
(Required.)
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10.
I need to work in the next 3 months:
(Required.)
Yes
No
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11.
I am willing to work an entry level position:
(Required.)
Yes
No
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12.
Do you have your EAD? (Employment Authorization Document)
(Required.)
Yes
No
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13.
What is your highest level of education?
(Required.)
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14.
What was your career in your home country?
(Required.)
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15.
Are you interested in professional training?
(Required.)
Yes
No
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16.
I am interested in professional recertification (the process of renewing or maintaining a certification or qualification) for my career.
(Required.)
Yes
No
I'm not sure
17.
What help do you need? (Fill in the blank)
Please allow us up to three weeks to contact you. We will contact you according to the information provided on the list. Thank you for understanding!