CRTC Program Home School Attended:

Student Name: Year Graduated: DOB: Gender: M F

Address: Telephone:

Completed Program? Yes No

High School Diploma? Yes No

Are you in: College Working Military Adult Education Other

If Other, please specify (i.e. homemaker, disabled, etc.)

If in Adult Education, specify Area of Study

Are you taking courses related to your training at CRTC? Yes No

Are you taking Other Training or Specialty Programs? Yes No If yes, specify

Are you attending a Two-year College Part-Time Full-Time Major

                               Four-year College Part-Time Full-Time Major

                               Technical College Part-Time Full-Time Major 

Have you completed a program of study at a:

Two-year college? Yes No Degree Major

Four-year college? Yes No Degree Major

Technical College? Yes No Degree Major

If attending a Technical College, did you enter through an Articulation Agreement? Yes No

Name of school you are attending:

Are you currently employed? Yes No (If NO skip remaining questions.)

Are you working in a position related to your program of study at CRATC? Yes No

Employer: Job Title:

Is employment: Full-Time (40 Hrs.) Part-Time (less than 40 Hrs.)

Does your employment include benefits? Yes No

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