All participants in the Pre-Employment Transition Services webinars are requested to answer the questions 1 through 4.
If you wish to learn more information about Vocational Rehabilitation, Independent Living, or Pre-Employment Transition Services, please complete the entire survey.

Filling out the survey does not obligate the student to apply for further services from Alpha One or the Division of Vocational Rehabilitation (DVR), but Pre-Employment Transition Services will help you decide what to do after graduation and will help your school provide courses in your upper class years. 

To pursue DVR services other than Pre-Employment Transition Services, you will need to complete an application and provide DVR with information needed to determine my eligibility.

Name of the Webinar ( select one)

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Name of the Webinar ( select one)

What did you like best about the webinar?

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What did you like best about the webinar?

What one thing would you change for future trainings?

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What one thing would you change for future trainings?

What is one action you will take as a result of this training?

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What is one action you will take as a result of this training?

 Please tell us about yourself and if you would like to receive further information.
 Name (first name, middle initial, last name)

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 Please tell us about yourself and if you would like to receive further information.
 Name (first name, middle initial, last name)

Select one

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Select one

What topic(s) would you like more information on?

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What topic(s) would you like more information on?

Are there other topic(s) you would like more information on? Tell us, below:

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Are there other topic(s) you would like more information on? Tell us, below:

Email Address

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Email Address

Gender

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Gender

Year of birth

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Year of birth

What is your mailing address?

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What is your mailing address?

City

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City

State

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State

Zip code

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Zip code

Phone Number

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Phone Number

What is the name of your school?

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What is the name of your school?

What grade are you in?

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What grade are you in?

What year do you expect to graduate high school ?

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What year do you expect to graduate high school ?

Do you currently have an Individual Education Plan (IEP)?

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Do you currently have an Individual Education Plan (IEP)?

Are you currently under a 504 Plan?

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Are you currently under a 504 Plan?

Other comments? Tell us, below:

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Other comments? Tell us, below:

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