CARDBoard Project

Fiber Optics Pre-Assessment

Pre-Assessment & Eligibility Screening Form

Client ID

Participant Contact Information

First Name (Nombre de pila) *

Last Name (Apellido) *

Date of Birth (Fecha de Nacimiento) *

Phone (Teléfono)

If you do not have a valid phone number, please enter: (000) 000-0000

Email (Correo Electrónico)

County

Purpose

This Pre-assessment tool helps CARDBoard Project staff evaluate participant readiness for the Fiber Optics Technician Training Program and identify supports needed for successful completion and job placement.

Fiber Optics Pre-Assessment – Eligibility

Pre-Assessment Requirements

Color Blind Test Score

Date Completed

O*NET Assessment Score

Date Completed

Technology Access

Do you have access to a reliable computer?

YesNo

Do you have a reliable internet connection?

YesNo

Program of Interest

Fiber Optics Training Program

Referral Information

Partner Referral / Location / Who referred you?

Partner Referral / Location

Partner Referral / Location Not Listed Above