Wired for Work
e-Training Profile
Participant
Name ___________________________
Date: ________________________
Phone# ___________________________
Gender: c Male
c Female
Age: ___________________________ ECS/CCS Score: _______________
School: c In-School
c Out-of-School
School
Attending: ___________________________________________________________________________
Ethnicity: (Please check all that apply)
c White
c Black/African American
c Hispanic/Latino c American Indian/Alaskan Native
c Asian
c Native Hawaiian/Pacific Islander
c Other
1. Are you interested in taking short-term
courses on-line?
c Yes
c No
2. Do you like to learn on your own,
at your own pace?
c Yes
c No
3. Are
you self-motivated and self-disciplined?
c Yes
c No
4.
Have you used a computer?
c Yes
c No
If Yes, how frequently do you…
Never/Rarely Daily Weekly
Monthly
Surf the Internet
c
c c
c
Shop on-line
c
c c
c
Use e-mail
c
c c
c
Bank/pay bills on-line
c
c c
c
Prepare Word documents
c
c c
c
Use Instant Messenger (IM)
c
c c
c
Previous on-line courses
c
c c
c
5.
Do you have an e-mail address?
c Yes
c No
E-Mail address:
______________________________________________________
6. What
kinds of courses and/or self-assessments do you think you’d like to take?
Business Skills Courses
c Yes
c No
(Telephone skills, Team
Building, Human Resources,
Accounting Fundamentals,
Management, Customer Service)
Desktop Courses
c Yes
c No
(Word, Excel, PowerPoint, Outlook, Quicken, Access)
Courses for IT Professionals
c Yes
c No
(Software development C+, Comp TIA A+, Oracle,
SQL, Adobe, Java, Paintshop Pro)
Healthcare Education Courses
c Yes
c No
(Medical Billing and Coding, Patient Education,
Healthcare Management, Home Health Services)
7. Where can you access high-speed Internet service?
At the CTWorks-East One-Stop Center
c Yes
c No
At Home
c Yes
c No
Library
c Yes
c No
School
c Yes
c No
Other (please state where) __________________________________________________
8. What are your career and/or e-training
goals?
________________________________________________________________________________________________________________________________________________________________________________________________________________________
______________________________________________________________________
