College and Career Survey
PRINT Name:_______________________________ GRADE:______ Diploma:_____________
___I am interested in attending the job shadowing program and may be interested in going to a
business one day a week for the last nine weeks. (10th and 11th grades ONLY)
___I am interested in doing a science internship at Jacksonville State University or other
colleges. (11th & 12th Grade ONLY)
___I am interested in taking career tech classes at Lincoln next year (9th, 10th, 11th graders) in
these areas:
__health science ___computer electronics ___carpentry
___I am interested in taking coop due to me having a job (must receive a paycheck) and leaving
school early (no more than 1-2 periods). (10th & 11th Grade ONLY)
My job is at ________________________________
Please check your MAIN field of interest of career!
___Business
___Education
___Social Work
___Human Resources
___Engineering
___Medical
___Arts
___Criminal Justice
___Computers
___Welding
___Electrical
___Plumbing
___Heating & Air
___Construction
___Farming
___Truck Driver
___Clerical
___Accounting
___Culinary
___Designer
___Auto/Mechanics ___Fast Food
___Travel/Tourism
___Military
___Sales/Retail
___Outdoors/Landscaping/Forest Service
___Don’t Know Yet ___OTHER:_______________________________
After High School, I plan to:
___Go to a junior academic college such as:_____________________________________
___Go to a junior career technical college such as:________________________________
___Go to a four year college/university such as:__________________________________
___ Join the military. Which branch?___________________________________________
___Go into the workforce in the area that I check above or _________________________
___Not sure, depends on money, etc…
Other Data: ___Male ___Female ___Black ___White ___Other
I am: __All A student __AB Student __C Student __C and Below Student
___I ride the school bus ___I drive or ride with another student __I ride with an adult
___I have internet access at home ___I do not have internet access at home
I live with: __both parents, married __one parent due to divorce __one parent, never married
__other than parent