Encore Contact Form (May 2018 - Present)

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* 1. Contact Information

Name

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 2. Employment status?

Full time

Part time

Not currently employed

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* 3. Have you ever taken courses here at Bucks?

Yes

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* 4. Current Bucks student status?

Full time

Part time

Not currently a student

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* 5. What level of education have you already obtained?

High school or GED

Some college

Associate Degree

Bachelor Degree

Master's Degree

Doctorate

Other (please specify)

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* 6. Please indicate your level of interest for each of these training options.

	Very interested	Slightly interested	Not interested at all
Help planning a career	Help planning a career Very interested	Help planning a career Slightly interested	Help planning a career Not interested at all
Choose a major (plan/focus of study)	Choose a major (plan/focus of study) Very interested	Choose a major (plan/focus of study) Slightly interested	Choose a major (plan/focus of study) Not interested at all
Resume writing	Resume writing Very interested	Resume writing Slightly interested	Resume writing Not interested at all
Interview prep	Interview prep Very interested	Interview prep Slightly interested	Interview prep Not interested at all
Job hunting tips	Job hunting tips Very interested	Job hunting tips Slightly interested	Job hunting tips Not interested at all
Individual appointments for career consultation	Individual appointments for career consultation Very interested	Individual appointments for career consultation Slightly interested	Individual appointments for career consultation Not interested at all

Other (please specify)

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* 7. How did you learn about Encore?

Website

Bucks brochure

Newspaper ad

Word of mouth

Other (please specify)

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* 8. Would you like to be contacted by Encore to schedule an Individual Consultation?

Yes

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* 9. If you would like to be contacted, do you prefer via email or phone?

Phone

Either email or phone is fine

n/a