Is This ITBiz Questionnaire?:
First Name:
Last Name:
Preferred/Chosen Name:
Email Address:
Race:
Gender:
County:
Preferred Pronouns:
Phone Number:
Street Address:
City:
State:
Zip Code:
Age:
Date of Birth:
Primary Language Spoken:
Number of dependents under 18 years old:
What is your Marital Status?:
Are you single parent of child under 18:
Emergency Contact Name:
Emergency Contact Phone Number:
Are you/your spouse Active Duty/Veteran:
Do you receive any following assistance?:
Highest Education Achieved:
Current Living Situtation:
Do you have access to Wi-Fi??:
Do you have access to a computer?:
Do you receive MediCal or MediCare?:
Annual Income:
Have you used virtual learning platform?:
Any knowledge about Cisco Systems?:
Do you have a lack of job experience?:
Do you have career attire?:
Do you have a resume?:
Do you have childcare?:
Do you have transportation?:
Do you have acceptable i9 documents?:
Do you have a U.S. Passport?:
Do you have a social security card?:
Have valid driver's license or ID:
Need employment after this course?:
Immediate need for a survival job?:
Are you currently employed? Where?:
Are you undocumented?:
Are you justice impacted or incarcerated:
Ever been in the foster care system?:
Are you a survivor of sex trafficking?:
Are you currently being sex trafficked?:
Are you currently being labor trafficked:
Are you a survivor of labor trafficking?:
Is a victim of interpersonal violence DV:
Is survivor of interpersonal violence DV:
Are you now in unsafe living environment:
Have you ever been diagnosed with::
Do you have an undiagnosed disability?:
Do you have a diagnosed disability?:
Any potentials barriers to employment?:
What are your goals for this cohort?:
How did you hear about ITbiz?: