Training & Support Inquiry
Please answer the following questions about your interest in training or other employment support. A member of our team will reach out to you to follow up. 
Sign in to Google to save your progress. Learn more
Email *
First Name
Last Name
Birthdate
MM
/
DD
/
YYYY
Preferred Pronoun
 Highest level of education completed
Clear selection
Phone Number
Street Number and Address
City
State
Zip Code
Do you have a Vocational Rehabilitation Counselor (VRC)?
Clear selection
Vocational Counselor's Name
Vocational Counselor's Email address
What technology do you use on a regular basis?
What type of tech training would you be interested in? You may select more than one option
What other types of training or support are you interested in? 
Are you currently job searching?
Clear selection
Please share any other information we should know about your training and support needs. 
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Perkins School for the Blind. Report Abuse