1. Current Employment Status

      6. Personal Goals
 Full-time                   Part-time         If I earned a certificate or associate degree,
        I would rather:
Homemaker              Full-time Student         Start my career right away.
Unemployed         Continue my education and earn a bachelor degree
          Have the options to do either/both.
2. Job Satisfaction  
(rate each statement as it applies to you, 5 - most important, 1 - least)         I feel I need improvement in the following areas:
A. I need a better income.....................................          Computer Skills
B. I would like a job with more responsibility.........         Accounting/Financial skills
C. I would like to be promoted..............................         Professional etiquette
D. I am concerned about job security.....................         Writing and grammar skills
            Mathematics skills
3. Previous Education         Management/People skills
High School Graduate/GED      Some College         Oral communication/
College Graduate                      Other:               Presentations/Meeting Facilitation
   
4. Education Satisfaction The following careers are in demand.
A. I am utilizing the education received.   Yes      No Check the fields that apply to you: ______________________________________________________
B. I would like specialized training to
     improve career opportunities.             Yes      No
 		                   
        Auditing
        Sales and Marketing
        Owning a Business
        Accounting
        Networking
        Web Design
        Advertising
        Hotel Management
        Desktop Publishing
Business Administration
Bookkeeping/Payroll
Retail Management
Database Management
Travel and Tourism
Tax Accounting
Office Assistant
Legal/Medical Assistant
Information Technology
C. I am willing to participate in short-term
     education to learn new skills and
     improve my employability and earning
     potential.                                            Yes      No
 
5. Financial Aid & Placement Assistance

Jamestown Business College graduates receive career placement assistance.  In addition, financial aid programs are available to those who quality.  Would you be more likely to attend college if you knew these services were available?                                                               Yes      No
 

Please complete if you would like more information

Personal Information     
First Name          MI   Last Name     Age (Optional)
Street Address    City      State    Zip
E-mail             
Home Phone    (999-999-9999)   Cell Phone      (999-999-9999)
Best time to call 
Current Occupation   Number of years    High School or GED Grad Year

____________________________________________________________________________________________________________________________

My Friend or relative may be interested
First Name          MI    Last Name   Age (Optional)
Street Address    City    State    Zip
E-mail             
Home Phone    (999-999-9999)   Cell Phone      (999-999-9999) 
Best time to call 
Current Occupation   Number of years    High School or GED Grad Year