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Encore Contact Form (May 2018 - Present)
1.
Contact Information
Name
Company
Address
Address 2
City/Town
State/Province
AL Alabama
AK Alaska
AS American Samoa
AZ Arizona
AR Arkansas
CA California
CO Colorado
CT Connecticut
DE Delaware
DC District of Columbia
FM Federated States of Micronesia
FL Florida
GA Georgia
GU Guam
HI Hawaii
ID Idaho
IL Illinois
IN Indiana
IA Iowa
KS Kansas
KY Kentucky
LA Louisiana
ME Maine
MH Marshall Islands
MD Maryland
MA Massachusetts
MI Michigan
MN Minnesota
MS Mississippi
MO Missouri
MT Montana
NE Nebraska
NV Nevada
NH New Hampshire
NJ New Jersey
NM New Mexico
NY New York
NC North Carolina
ND North Dakota
MP Northern Mariana Islands
OH Ohio
OK Oklahoma
OR Oregon
PW Palau
PA Pennsylvania
PR Puerto Rico
RI Rhode Island
SC South Carolina
SD South Dakota
TN Tennessee
TX Texas
UT Utah
VT Vermont
VI Virgin Islands
VA Virginia
WA Washington
WV West Virginia
WI Wisconsin
WY Wyoming
ZIP/Postal Code
Email Address
Phone Number
2.
Employment status?
Full time
Part time
Not currently employed
3.
Have you ever taken courses here at Bucks?
Yes
No
4.
Current Bucks student status?
Full time
Part time
Not currently a student
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)
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
Very interested
Slightly interested
Not interested at all
Choose a major (plan/focus of study)
Very interested
Slightly interested
Not interested at all
Resume writing
Very interested
Slightly interested
Not interested at all
Interview prep
Very interested
Slightly interested
Not interested at all
Job hunting tips
Very interested
Slightly interested
Not interested at all
Individual appointments for career consultation
Very interested
Slightly interested
Not interested at all
Other (please specify)
7.
How did you learn about Encore?
Website
Bucks brochure
Newspaper ad
Word of mouth
Other (please specify)
8.
Would you like to be contacted by Encore to schedule an Individual Consultation?
Yes
No
9.
If you would like to be contacted, do you prefer via email or phone?
Email
Phone
Either email or phone is fine
n/a
