Green Jobs Corps Initiative


Participant Interest Survey

1
*

Date and Time:

MM DD YYYY HH MMAM/PM
Date/Time
/
/
 
:
2
*

Name:

3
*

Address:

4
*

City:

5
*

Zip Code:

6
*

Telephone:

7

Cell or Alternate Telephone:

8

Email Address:

9
*

Age 

10
*

School Status

11
*

School Completion (Choose All That Apply):

12

If you attend school (high school, community college, university), in what school are you enrolled?

13
*

Are you interested in learning more about "green" jobs and learning skills in green industries?

14
*

Are you interested in learning more about "green" landscaping and gardening, as well as organic harvesting of fruits and vegetables?

15
*

Are you interested in learning skills associated with recycling and conservation?

16
*

Are you interested in learning about careers in energy efficiency, "green" construction, weatherization, and environmental land clean-up?

17

What services are you interested in receiving?

18

How did you hear about the program?

19

Are there any comments you would like to add?

Thank you for your interest and time.  We will be contacting eligible youth shortly to talk further about opportunities available with the Green Jobs Corps.

 

Image as described above
Powered by SurveyMonkey
Check out our sample surveys and create your own now!