JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Student Intake Form
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Name
*
Your answer
If you wanted an individual appointment with the career coach, when would be the best time?
*
1st Period
2nd Period
3rd Period
4th Period
5th Period
6th Period
7th Period
What colleges are you interested in attending? Check all that apply:
*
University of Arkansas at Hope - Texarkana
Southern Arkansas University
Henderson State University
Arkansas State University
Arkansas Tech University
Texarkana College
Cossatot Community College (Ashdown)
Northeast Texas Community College (Mt. Pleasant)
Texas State Technical College (Marshall)
University of Arkansas at Little Rock
Texas A&M - Texarkana
University of Central Arkansas
University of Arkansas (Fayetteville)
Other:
Required
What career fields are you interested in? Check all that apply
*
Agriculture (including Agriculture Education)
Architecture/Construction
Arts/Communication
Business Management
Education and Training
Finance
Government and Public Administration
Health Sciences
Hospitality and Tourism
Human Services
Information Technology (Computer Technology)
Law, Public Safety, Security, and Corrections
Manufacturing
Marketing, Sales, and Service
Science, Technology, Engineering, and Mathematics
Transportation, Distribution, and Logistics
I am not sure
Other:
Required
I need help:
*
Determining what types of careers interest me
Creating a plan to reach a certain career goal
Exploring my education options after high school (college, technical school, military, workforce, etc)
Deciding what I should major in when I go to college
Getting a job right out of high school
Joining the military
Required
What obstacles/challenges do you face in the career planning process?
*
Too many interests
Not enough interests
Low motivation
Low confidence
Lack of career information
Lack of postsecondary (college/technical school) information
Academic issues
Financial issues
Pressure from others
Other:
Required
What is the most important goal you'd like to accomplish through working with the career coach?
*
Your answer
Who or what have been the biggest influences on your career interests? Why?
*
Your answer
What are some careers you have considered so far?
*
Your answer
What are your favorite school subjects? Why?
*
Your answer
What are your least favorite school subjects? Why?
*
Your answer
List three things you are excel at:
*
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of University Of Arkansas Community College at Hope, Texarkana.
Report Abuse
Forms
