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Itawamba Career & Technical Center
Needs Assessment Survey 2023-2024
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* Indicates required question
1. Name (First & Last)
*
Your answer
2. Gender:
*
Female
Male
Other:
3. Date of Birth
*
MM
/
DD
/
YYYY
4. Mailing Address
*
Your answer
5. Ethnicity
*
White
Black
Asian
Hispanic
Other:
6. School:
*
Itawamba
Mantachie
Tremont
7. Grade
*
9
10
11
12
8. Block at ICTC
*
1st
2nd
3rd
9. Which CTE Program(s) are you enrolled in?
*
Automotive Services I
Automotive Services II
Collision Repair I
Collision Repair II
Construction I
Construction II
Culinary I
Culinary II
Digital Media I
Digital Media II
Health Science I
Health Science II
Welding I
Welding II
Work-Based Learning
Required
10. Parent/Guardian Name and Phone Number
*
Your answer
11. Please check any condition that applies to you.
*
Allergies (food, insects, etc)
Asthma
Diabetes
Epilepsy
Physical Disability
Visual Disability
None
Other:
Required
12. Which Meal Plan Do You Qualify For?
*
Free/Reduced
Full Price
13. Are you a
non-traditional
student at ICTC?
(Check Yes if you are a
female
in Automotive Services, Collision Repair, Construction, Culinary Arts, or Welding. Otherwise, check No)
*
Yes
No
14. Are
YOU
a single parent or currently expecting a child?
*
Yes
No
15. Language Spoken Most Often in Your Home
*
English
Spanish
Other
16. Who do you live with?
*
Parent(s)
Grandparent(s)
Guardian
Relative
Foster Home
Other:
17. Is Your Parent on Active Duty
(in the military)
?
*
Yes
No
18. Please check the state tests that you will take this year, will re-take this year, or have already taken. If you have not taken one or more of the tests and will not take it (them) this year, check Not Applicable.
*
Will TEST 1st Semester
Will RETEST 1st Semester
Will Test 2nd Semester
Will RETEST 2nd Semester
Already Taken
Not Applicable
Algebra I
Biology I
English II
US History
Will TEST 1st Semester
Will RETEST 1st Semester
Will Test 2nd Semester
Will RETEST 2nd Semester
Already Taken
Not Applicable
Algebra I
Biology I
English II
US History
19. List any clubs, organizations, or teams you belong to. If none, state None.
*
Your answer
20. List any special needs or accommodations you would like to share. If none, state None.
*
Your answer
21. What are your plans following high school?
*
Go to Work
Attend a community college
Attend a University
Attend a Trade School
Join the Military
Not sure
22. What Career are you interested in?
*
Your answer
ICTC does not discriminate against anyone protected by law on the basis of race, color, national origin, religion, sex, or disability and provides equal access to all students.
All information will be kept confidential and will be used for Student Services only.
Mrs. Tamara Todd, Student Services Coordinator
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