Evaluación de Preparación Laboral [ English ] School Name*Head of Household DataName* First Middle Last Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home PhoneCell PhoneEmail Household Composition Data(Includes everyone living at the same address)Name* First Last Sex* Male Female Birthdate Month Day Year RelationshipRaceGradeSchoolHome PhoneCell Phone Add household member Remove household member Household MemberName* First Last Sex* Male Female Birthdate Month Day Year RelationshipRaceGradeSchoolHome PhoneCell Phone Add household member Remove household member Household Income DataName* First Last Income TypeEnter monthly amount into the appropriate fieldPaycheckTANFUnemploymentFood StampsOther Add household member Remove household member Household MemberName* First Last Income TypeEnter monthly amount into the appropriate fieldPaycheckTANFUnemploymentFood StampsOther Add household member Remove household member If you entered any "other" income, please explainSchool Related DataDo you attend PTA meetings?* Yes No Do you attend teacher's conferences?* Yes No Do you attend school conferences?* Yes No Is school attendence important to you?* Yes No Are good grades important to you?* Yes No Is high school graduation a goal for your child(ren)?* Yes No Is college or vocational school a goal for your child(ren)?* Yes No Do you think graduating from high school will help your child(ren) get a better job and thus improve his/her life?* Yes No Do you think graduation from college will help your child(ren) get a better job and thus improve his/her life?* Yes No Has your child(ren) been held back a grade at any time?* Yes No When?*Do you know in which classes your child(ren) is having trouble?* Yes No Please list each class Click the plus sign to add another class to the list
