Career Pathways Screening Assessment
Name: _______________________________________ Date: _______________
Phone 1: _________________ Email/Phone 2: ____________________________
1- Career/education goals or interests (What type of job would you like when you
finish training?)
1a-How long do you want to spend going to school?
2-Work and Education Experience (past jobs, job-related training, level of education)
3-Strengths, skills, resources (personal & school/job-related, i.e. organization,
knowledge about college, access to resources, support systems, student success skills)
3a-Level of computer knowledge/skills (ask if completed computer classes)
4-What would make it difficult for you to attend college?
Lack of identification
Driver’s License Lapsed, out of state,
suspended or revoked
Not a U.S. Citizen, Temporary
Resident or Permanent Resident
No Social Security #
Ex-offender status
Disability: learning, ADD/ADHD,
concentration, memory, other
Mental health issues
Unsure how to complete forms for
enrollment or financial aid
Need financial aid
In default on a student loan
Not sure what schools have programs
I’m interested in
Transportation: need money to pay
Transportation: no reliable transport.
Housing: currently homeless or looking
to move to other housing
Need help looking for childcare
Need help applying for DSHS/childcare
benefits
Want to go to college full-time and
need help with living expenses
Work schedule OR want to work parttime while attending school
Scheduling: a lot of medical, other
health or mental health appointments
No computer access
Don’t know how to use computers
No telephone # or phone access
Need tutoring or help with
math/writing/other basic skills
Other: ___________________________
5-Overview of CC101 class and CP program; Sign Participant Agreement
6a-CC101 topics; what specific things can students expect to get from class?
6b-CP support services: advising, help with financial aid, support navigating &
linking to people at colleges, meeting basic & school-related needs, resources
6c-Emphasize time/attendance commitment: MUST attend all classes since
each class builds on previous; MUST attend 1 tour
6d-Emphasize goal of transitioning students into college program the next qtr
____________________________________________________________________
RESULT: _____ Enroll
_____ Deny: Reason_________________________________________
______ Refer to other class ____________________________________________________________
______ Refer to community resource ____________________________________________________
______ Hold—client is unsure, still needs to decide
Career Pathways Screening Assessment Checklist
Name: ____________________________________________________________
ELIGIBILITY:
*CASAS 30 Reading: 215+; specify score: _____________________________________
Good English listening skills
Basic computer literacy: General comfort, Internet, Basic typing
OR
Concurrent enrollment in a Goodwill computer class
Interest in Prof-Tech program at community college (NO transfer degrees)
*NO Bachelor’s Degree or higher
BA/BS outside of U.S.: ST training programs (1 yr/4 qtrs Cert) or payment plan
WA State Resident (can document 1 yr residency in WA)
OR
Within 3 mos of residency; specify length of time in WA: ____________________
OR
*Receiving UI or Food Stamps (circle applicable)
OR
Eligible for UI or Food Stamps (circle applicable), but not currently receiving
SSN/Temporary or Permanent Resident status
OR
Eligible to apply for SSN/U.S. Resident status
OR
Interest in ST Cert program (two quarters or less)
OTHER:
*Verify phone # & email (if applicable)
*Has HS Diploma/GED
Completed any college classes; name of college: ____________________________________
*Associate’s Degree; name of college: _____________________________________________
*Other Public Benefits; specify type (TANF, Unemployment, Basic Food, Veteran’s):
_________________________________________________________________________________
*Currently employed;
PT
FT
Contract/temporary
Self-employed
OR
*Currently unemployed
Has Driver’s License/Picture ID
For students interested in Health Professions and Early Education ONLY:
*Any convictions, arrests, etc.; specify type: _______________________________________
Have healthcare license from another country; specify country: _______________________
COLLEGE PREFERENCE:
Renton Tech
Shoreline CC
South Seattle CC
Bellevue College
Seattle Central
Other; Specify: ________________________________________________________________
No preference/Don’t Know