Participant Application Form
* Required
1. Name
*
First and last name
Your answer
2. Email
*
Your answer
3. What is your phone number?
*
Your answer
4. What is your address?
*
Your answer
5. What gender do you identify with?
*
Female
Male
Prefer not to say
Other:
6. What is your age?
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Choose
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7. What is your ethnicity?
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Hispanic or Latino
White
Black or African American
Native American or American Indian
Asian/Pacific Islander
Other:
Required
8. What is the highest degree or level of school you have completed? If currently enrolled, highest degree received.
*
Some high school, no diploma
High school diploma
Some college credit. no degree
Trade/technical/vocational training
Associate degree
Bachelor’s degree
Master’s degree
Professional degree
Doctorate degree
9. What is your marital status?
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Single, never married
Married or domestic partnership
Widowed
Divorced
Separated
Other:
10. Are you currently...?
*
Employed for wages
Out of work and looking for work
A student
Other:
11. Name of current employer/business and position
Your answer
12. Years at the current position
1-3
3-6
6-9
9-12
Other:
12. Name of current school/training program
Your answer
13. Years left to complete
1
2
3
4
5
14. What is your annual household income?
*
Your answer
15. Skill sets/abilities/knowledge?
*
Your answer
16. What are your areas of interest?
*
Your answer
17. What are your strengths?
*
Your answer
18. Briefly describe your aspirations? Elaborate on where you see yourself in five (5) to ten (10) years from now? What are your plans for achieving your goals?
*
Your answer
Growth Mindset
Growth Mindset evolves from an attitude of hard work, training, and perseverance. In comparison, individuals with a fixed mindset believe that success comes from innate ability, focusing on the rewards of immediate success and dread failure.
19. Provide a real life example when you applied a Growth Mindset and how you benefited from it?
Your answer
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