_________________________________________________________________________________________ *Name: Last First Middle/Former Name Suffix STUDENT GOALS *What do you want to achieve by attending the adult education program? (Completed prior to assessment) Improve Skills in: Education Goals: Career Goals: Reading Earn a GED diploma Find a job Math Enroll in a technical college Keep my job Writing Enroll in a private training program Find a better job Science Enroll in a 4-year college Complete a career assessment Social Studies Pursue an apprenticeship Improve English Language Skills in: *Integrated English Literacy/Civics Education (IEL/CE): Achieve citizenship skills Speaking Listening Achieve U.S. citizenship (Georgia goal) Reading Increase involvement in community activities Writing Vote or register to vote FOR PROGRAM USE ONLY: The interviewer should complete this section during an initial conference with the student after his/her pre-assessment. What is the student’s primary reason for enrolling? What services will the program provide the student? What are the college, student’s career, or other goals? Did the student share any personal barriers that could affect program participation? If yes, please explain. Additional Notes: *Student’s Signature: *Date: Sign in ink Signature: *Interviewer’s *Date: Sign in ink Please note: Teachers should conference with the student at least once per quarter. Conference notes must be maintained either in hard copy format in the student permanent record or in GALIS. More information is available in the Intake Assessment Form Directions and Definitions document.
*Name: _________________________________________________________________________________________ Last First Middle/Former Name Suffix STUDENT GOALS *What do you want to achieve by attending the adult education program? (Completed prior to assessment) Improve Skills in: Education Goals: Career Goals: Reading Math Writing Science Social Studies Earn a GED diploma Enroll in a technical college Enroll in a private training program Enroll in a 4-year college Find a job Keep my job Find a better job Complete a career assessment Pursue an apprenticeship Improve English Language Skills in: Speaking Listening Reading Writing *Integrated English Literacy/Civics Education (IEL/CE): Achieve citizenship skills Achieve U.S. citizenship (Georgia goal) Increase involvement in community activities Vote or register to vote FOR PROGRAM USE ONLY: The interviewer should complete this section during an initial conference with the student after his/her pre-assessment. What is the student’s primary reason for enrolling? What services will the program provide the student? What are the student’s college, career, or other goals? Did the student share any personal barriers that could affect program participation? If yes, please explain. Additional Notes: *Student’s Signature: Sign in ink *Date: *Interviewer’s Signature: Sign in ink *Date: Please note: Teachers should conference with the student at least once per quarter. Conference notes must be maintained either in hard copy format in the student permanent record or in GALIS. More information is available in the Intake Assessment Form Directions and Definitions document.
FY18%20Intake%20Assessment%20Form.docx