Enrollment Needs Assessment Questionnaire
Help us understand your needs and preferences to support your successful enrollment.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Which program or service are you enrolling in?
*
Please Select
General Education
Vocational Training
Adult Learning
Language Course
Other
Please indicate your current status:
*
Student
Employed
Unemployed
Other
Which of the following areas do you feel you need support with? (Select all that apply)
*
Academic Skills
Time Management
Technology Use
Language Skills
Financial Assistance
Other
How confident do you feel in the following areas?
*
Rows
Not confident
Somewhat confident
Confident
Very confident
Reading and Writing
1
2
3
4
Math Skills
5
6
7
8
Using Technology
9
10
11
12
Communicating with Others
13
14
15
16
What is your preferred way to receive information?
*
Email
Phone Call
Text Message
In Person
Other
Do you have reliable access to the following?
*
Rows
Yes
No
Computer or Laptop
17
18
Smartphone
19
20
Internet Connection
21
22
Quiet Study Space
23
24
Please rate your overall readiness to begin the program.
*
1
2
3
4
5
Are there any barriers or challenges that might affect your participation? (Select all that apply)
Transportation
Childcare
Work Schedule
Health Issues
None
Other
Please share any additional information or needs you would like us to know about.
Submit
Should be Empty: