Workability-IV Interest Form

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Greetings students!

Are you thinking about your future?

This is a special program that can PAY for your TUITON, your BOOKS, your supplies, and even your PARKING!

It isn't a loan. It isn't a grant. It isn't a scholarship.

This is a unique partnership with the Department of Rehabilitation just for people with disabilities to go to college while eliminating some of the barriers to access.

We get students ages 16-21 ready for school, work and life!

Our Workability program assists hundreds of individuals with disabilities with a successful transition into higher education and work. We bring you self advocacy skills and workforce preparation. It is entirely free, confidential, and individualized to you --thanks to our very skilled and knowledgeable staff.

Access your brightest and best future today with Workability! Please sign up!

For more information, please email Workability Interim Faculty Director Jessica Nerren at jessica.nerren@csusb.edu.

We hope you join us today!

-Dr. Jess

What is your first name? *

What is your last name? *

What is your email?

What is yours or your parent's cell number? (we do not distribute at all, this is just to reach out to you as a last resort)

What is your age? (please select one) *

Younger than 16

16-17

18-21

22+

Please tell us about yourself (check all that apply)

I am a person with a disability

I am a parent or person who is part of a support network for a person with a disability

I am in high school

I am in college

I am interested in...
*

Learning more about the world of work

Understanding what it takes to be successful in a job

Gaining more work experience

Thinking about my future after school

Required

I like the idea of learning more about (please select all that apply) *

Self Advocacy

Job Exploration Coaching

Workforce Learning Experiences

Other:

Required

My best days and times to be reached or for future activities include (please select all that apply)

Morning

Noon

Afternoon

Evening

Monday

Tuesday

Wednesday

Thursday

Friday

I am currently a Department of Rehabilitation client

Yes

Clear selection

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