GSI Enrollment Application

The Enrollment Survey for the Green Stormwater Infostructure program (GSI) is designed to gather essential information from prospective participants to better understand their interests, needs, and goals. This survey serves as a vital tool for streamlining the enrollment process and tailoring the program experience to meet the diverse requirements of students.

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* 1. Are you a Pierce County Resident?

Yes

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* 2. Are you between 18- 26 years old?

Yes

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* 3. Are you eligible to work in the U.S.?

Yes

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* 4. Personal Details

First Name

Last Name:

Middle Name:

Age:

Date of Brith:

Race/ Ethnicity

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* 5. Address:

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

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* 6. Emergency Contact:

First and Last Name:

Phone Number:

Relationship to you:

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* 7. Education:

Highest Level Completed:

Do you have a high school diploma/GED:

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* 8. Transportation:

Do you have a Washington State Driver's License?

Do you have a car?

Is your car registered?

Do you have car insurance?

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* 9. Household Information:

How many people live in your house?

Do you feel safe at home?

Do you live with family or on your own?

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* 10. Each of the following must be answered:

	Yes	No
Have you dropped out of school with no diploma or GED?	Have you dropped out of school with no diploma or GED? Yes menu	Have you dropped out of school with no diploma or GED? No menu
Are you still enrolled in school but haven't attended during the current or previous quarter?	Are you still enrolled in school but haven't attended during the current or previous quarter? Yes menu	Are you still enrolled in school but haven't attended during the current or previous quarter? No menu
Are you currently, or have you had previous involvement with the legal/justice system?	Are you currently, or have you had previous involvement with the legal/justice system? Yes menu	Are you currently, or have you had previous involvement with the legal/justice system? No menu
Are you currently experiencing a lack of stable housing?	Are you currently experiencing a lack of stable housing? Yes menu	Are you currently experiencing a lack of stable housing? No menu
Are you a minor (age 17 or younger) who has left your parents or legal guardians without permission?	Are you a minor (age 17 or younger) who has left your parents or legal guardians without permission? Yes menu	Are you a minor (age 17 or younger) who has left your parents or legal guardians without permission? No menu
Are you currently, or have you previously received foster care services?	Are you currently, or have you previously received foster care services? Yes menu	Are you currently, or have you previously received foster care services? No menu
Are you pregnant or parenting?	Are you pregnant or parenting? Yes menu	Are you pregnant or parenting? No menu
Do you have a disability?	Do you have a disability? Yes menu	Do you have a disability? No menu
Do you experience challenges with the English language due to English not being your first language or living in a community where English is not the primary language?	Do you experience challenges with the English language due to English not being your first language or living in a community where English is not the primary language? Yes menu	Do you experience challenges with the English language due to English not being your first language or living in a community where English is not the primary language? No menu

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* 11. Part A - Basic Skills

	Yes	No
Can you read?	Can you read? Yes	Can you read? No
Do you understand what you are reading?	Do you understand what you are reading? Yes	Do you understand what you are reading? No
Do you struggle with math?	Do you struggle with math? Yes	Do you struggle with math? No
Do you communicate effectively?	Do you communicate effectively? Yes	Do you communicate effectively? No
Can you cook your own food?	Can you cook your own food? Yes	Can you cook your own food? No
Can you wash your own clothes?	Can you wash your own clothes? Yes	Can you wash your own clothes? No
Do you know how to operate a computer?	Do you know how to operate a computer? Yes	Do you know how to operate a computer? No
Do you do daily household chores?	Do you do daily household chores? Yes	Do you do daily household chores? No
Do you know how to drive a car?	Do you know how to drive a car? Yes	Do you know how to drive a car? No
Do you have a driver's license?	Do you have a driver's license? Yes	Do you have a driver's license? No

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* 12. Part B - Occupational Skills

	Yes	No
Are you patient?	Are you patient? Yes	Are you patient? No
Are you determined?	Are you determined? Yes	Are you determined? No
Do you have good time management skills?	Do you have good time management skills? Yes	Do you have good time management skills? No
Are you a problem solver?	Are you a problem solver? Yes	Are you a problem solver? No
Do you have organizational Skills?	Do you have organizational Skills? Yes	Do you have organizational Skills? No
Can you use a hammer or other tools?	Can you use a hammer or other tools? Yes	Can you use a hammer or other tools? No
Are you a good leader?	Are you a good leader? Yes	Are you a good leader? No
Do you have a forklift certification?	Do you have a forklift certification? Yes	Do you have a forklift certification? No
Can you read a tape measure?	Can you read a tape measure? Yes	Can you read a tape measure? No
Do you have a flagger certification?	Do you have a flagger certification? Yes	Do you have a flagger certification? No
Can you lift heavy items?	Can you lift heavy items? Yes	Can you lift heavy items? No
Can you individually complete tasks?	Can you individually complete tasks? Yes	Can you individually complete tasks? No
Do you work well on a team?	Do you work well on a team? Yes	Do you work well on a team? No
Do you jump in to get tasks done?	Do you jump in to get tasks done? Yes	Do you jump in to get tasks done? No
Do you work well on a team?	Do you work well on a team? Yes	Do you work well on a team? No
Do you have good customer service skills?	Do you have good customer service skills? Yes	Do you have good customer service skills? No
Are you good at following written or verbal directions?	Are you good at following written or verbal directions? Yes	Are you good at following written or verbal directions? No

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* 13. Part C - Prior Work Experience

Have you ever worked a job?

Where have you worked?

What tasks did you have to do?

Have you ever volunteered or done chores around the house?

What did they have you do?

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* 14. Part D - Employability

What is the longest have worked at a job?

How do you like to receive feedback on your work?

Did you get along with your co-workers?

Do you have priorities that distract you from work?

Why did you leave your last job?

Have you ever been fired from a job? If yes, please briefly describe what occurred.

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* 15. Part F - Aptitudes

What tasks do you struggle with daily?

Do you speak any other Languages?

How do you find an answer to something you're curious about?

How do you prioritize your tasks throughout your day?

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* 16. Part G - Supportive Service Needs

	Yes	No
Steel Toed Boots	Steel Toed Boots Yes	Steel Toed Boots No
Construction Work Clothing	Construction Work Clothing Yes	Construction Work Clothing No
Personal Protective Equipment	Personal Protective Equipment Yes	Personal Protective Equipment No
Assistance with Utility Bills	Assistance with Utility Bills Yes	Assistance with Utility Bills No
Driver's license	Driver's license Yes	Driver's license No
Gas Cards	Gas Cards Yes	Gas Cards No
Bus Pass	Bus Pass Yes	Bus Pass No
Rental Assistance	Rental Assistance Yes	Rental Assistance No
Cell Phone	Cell Phone Yes	Cell Phone No
Food	Food Yes	Food No
Other	Other Yes	Other No

Other (please specify)

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* 17. Part H - Developmental Needs

How do you manage intense emotions or stress?

Do you become anxious or overwhelmed throughout the day?

What support would help you be successful in a classroom setting?

If you have a disability, what are supports that help you?

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* 18. Part I - Strengths

What do you believe you are really good at?

Do you value attendance, promptness, integrity, and honesty?

What is the best quality that you know about yourself?