JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
EIPA Screener Need Survey
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Name
*
Your answer
Email Address
*
Your answer
EIPA Status (check all that apply)
*
Taken the EIPA but have not scored 3.5 or higher
Taken the EIPA within the last month or two and am waiting on results
Taken the EIPA within the last 3-6 months and am waiting on results
Taken the EIPA over six month ago and am waiting on results
Taken the screener
Scheduled to take the EIPA
Required
Where would you prefer to take the Screener?
*
Greeley/Ft. Collins Area
Denver Metro Area
Colorado Springs/Pueblo Area
Grand Junction Area
1st preference
2nd preference
Not an option for me
Greeley/Ft. Collins Area
Denver Metro Area
Colorado Springs/Pueblo Area
Grand Junction Area
1st preference
2nd preference
Not an option for me
What time of day would you prefer to take the screener
*
Weekday morning
Weekday afternoon
Weekend morning
Weekend afternoon
1st preference
2nd preference
Not an option for me
Weekday morning
Weekday afternoon
Weekend morning
Weekend afternoon
1st preference
2nd preference
Not an option for me
Current Employment Status
*
Currently employed with a school district
Seeking employment with a school district
Questions for Shauna Moden and/or Pat Himes
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Colorado Department of Education.
Report Abuse
Forms
