New Client Survey

Tailored for Success, Inc. - New Client Survey

This form is for job seekers in Massachusetts (Middlesex or Suffolk counties) interested in receiving business clothing for an upcoming interview, internship or new job. All information collected will be kept confidential.

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* 1. First and Last Name:

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* 2. Email

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* 3. Full Mailing Address

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* 4. Age

18-25

25-35

35-55

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* 5. Ethnicity

White or Caucasian

Black or African American

Hispanic or Latino

Asian or Asian American

American Indian or Alaska Native

Native Hawaiian or other Pacific Islander

Another race

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* 6. Household income

Under $15,000

Between $15,000 and $29,999

Between $30,000 and $49,999

Between $50,000 and $74,999

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* 7. Gender

Male

Female

Transgender

Other

Prefer Not to Answer

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* 8. Employment Status

Unemployed

Employed Part-time

Student

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* 9. Were you referred by an agency?

Yes

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* 10. If answer to Question 8 is yes, please indicate agency.

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* 11. Do you need an appointment at one of our Career Closets?

Yes