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Adult Ed. Entrance Survey
We aim to support our students in the classroom and in the community as much as possible. Please answer the following questions so we can best meet your needs and help you reach your goals.
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Your name:
*
Your answer
The center where I attend Adult Ed classes is:
*
Canton Campus
Macomb Campus
Havana Campus
Rushville Campus
Online/Canvas class
Which goal(s) are you hoping to achieve while enrolled in this program? Please check all that apply:
Pass the GED and obtain an IL High School Diploma
Obtain skills to get a better paying job
Enroll in a training program or college courses upon completion
Enlist in a branch of the military
Other:
What strengths do you feel you have that will help you achieve these goals? Please check all that apply:
I'm well organized.
I'm highly motivated.
I can easily focus on tasks without much redirection.
School tasks tend to be easy for me.
Other:
Which areas do you feel could use some improvement?
Organization (thoughts or materials for a task)
Motivation
Focus and attention to task
Reading skills
Math skills
Other:
What is your current employment status?
Employed Full Time
Employed Part Time
Not employed, but looking for a job
Not employed, but not looking
Other:
Clear selection
Who is living with you in your household?
Your answer
Are there any religious holidays you observe that you'd like us to be aware of?
Your answer
Which academic subjects are easiest/most enjoyable for you? Choose all that apply:
Reading
Writing
Math
Science
Social Studies/History
Other:
Which academic subjects are difficult/your least favorite? Check all that apply:
Reading
Writing
Math
Science
Social Studies/History
Other:
Did you have any academic accommodations in school that were helpful to you? If so, please list them here:
Your answer
We are able to connect our students to other agencies in the community. Are you needing help finding resources in any of the following areas? Check all that apply:
Employment search
Resume writing
Mental health/counseling
Applying for WIC/SNAP/MEDICAL CARD/ETC.
Housing
Food assistance
Childcare
Clothing/Household items
Health Care/Dental Care
Crisis Intervention Services
Recovery/Addiction Services
Other:
What is your favorite movie and/or TV show?
Your answer
What's your favorite book?
Your answer
Where is your dream vacation?
Your answer
Who is your favorite musician?
Your answer
What kinds of things stress you out?
Your answer
What kinds of things help you feel relaxed?
Your answer
Do you enjoy any of these types of games? Check all that apply:
Video games on a console (XBox, Playstation, etc.)
Video games on a computer
Games on the phone (Candy Crush, Plants v. Zombies, etc.)
Board games (Monopoly, Scrabble, Catan, etc.)
Card Games (Poker, Solitaire, Rummy, Euchre, Pitch, etc.)
Other
What are the things that matter most to you in life? Why are they important to you?
Your answer
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