Connected Teens Pre-Enrollment Survey 
This is an opportunity to gather basic information as a pre-requisite to enrolling in the Connected Teens program and to best serve the needs of the group.
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Email *
Teen's Full Name *
Date of Birth *
Parents' Full Name (s) *
Parent's Phone Number (s) *
Teen's Phone Number (if applicable) *
Last School Attended *
Which days are you enrolling in? *
Required
Teens: List your hobbies, interests, strengths, talents, and challenges *
Teens: From the options below, which is your preferred learning environment? *
If you chose "other" in the last question please explain
Teens: Which describes your learning style best? *
Teens: Which subjects are you most confident in and/or enjoy most? Why? *
Teens: Which subjects are you most challenged by? Why? *
Parents: Which subjects or aspects of life do you feel most engaged with your teen in? For example, playing sports, making art, or writing stories together. *
Parents: Which subjects or aspects of life are you wanting to connect more with your teens in? *
Parents: Which subjects or aspects of life do you notice your teens have the most difficulty in? *
Please write about any volunteer and/or work experience. *
Teens: Please write about your goals for your education, experience, and life skills development. *
Parents: Please write about what your goals are for your teen's education, experience, and life skills development. Are they the same as your teens' goals? *
What is the interest level and availability for participation in and co-hosting events in the community outside of program hours? What are the best days and times of the week for these? Would parent(s) be available to assist? *
Overall health-related concerns you feel comfortable mentioning? (enrollment forms will have a HIPPA compliant process to list medications and more specific health questions) *
Do financial hardships determine your teen's participation in the program? (partial scholarships may become available) *
Parents and teens: Any specific questions or feedback you'd like to mention? Please directly email, text, or FB message me after you send in this form so I am aware of it (google forms does not notify me).  Thank you! *
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