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* 1. Which provider offered the course?

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* 2. Date of course:

Date

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* 3. What course are you attending?

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* 4. How comfortable are you with this course topic?

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* 5. How knowledgeable are you about this course topic?

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* 6. How confident are you in your ability to obtain and retain employment?

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* 7. How confident are you in your ability to take care of and manage your family situation?

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* 8. Are you or a member of your household currently receiving public assistance? If so, check all that apply.

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* 9. Did you take advantage of the following to attend this course? Check all that apply.

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* 10. Are you currently employed?

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* 11. Have you previously received services from the Department of Labor and Regulation/Job Service?

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* 12. Are you interested in having the Department of Labor and Regulation share more about employment services and training opportunities?

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