Green Jobs Corps Initiative

Participant Interest Survey

Questions marked with an asterisk (*) are mandatory.
1

* Date and Time:

MonthDayYearTime
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):

I am attending high school.
I graduated from high school.
I received a GED / High School Diploma.
I dropped out of high school.
I need to get a GED or High School Diploma.
I am attending a community college.
I am attending a university.
Other, please specify:
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?
Additional Comment
14

* Are you interested in learning more about "green" landscaping and gardening, as well as organic harvesting of fruits and vegetables?
Additional Comment
15

* Are you interested in learning skills associated with recycling and conservation?
Additional Comment
16

* Are you interested in learning about careers in energy efficiency, "green" construction, weatherization, and environmental land clean-up?
Additional Comment
17

What services are you interested in receiving?
18

How did you hear about the program?

Summer Youth Employment Training Program
Youth Opportunity Center
Career Transition Center
Long Beach Job Corps
Conservation Corps of Long Beach
Long Beach Community Action Partnership
Other, please specify
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.