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Customized Employment & Training Plan

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Today's Date
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Name
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Home Address
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Phone : Day
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What is your goal at De Anza? Certificate A.A Degree
Transfer
Describe your Certificate/ Degree/ Major:
Are you enrolled in any special programs (OTI, EOPS, SLAMS etc.)?
Are you currently working? Yes No
If you answered Yes to the previous question F/T P/T
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What is your employment goal after graduation?
Age Group:
Ethnicity:

If not citizen or permanent resident, include visa status:


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Limited English Disabled  
Academically disadvantaged Single Parent
Criminal Offender Economically disadvantaged
Displaced Homemaker Transportation Issues
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Sign up for an appointment at the ATC203 Information Desk!!
Or call  : Blanche Monary - (408) 864-5530
Employment Planning and Resource Center Office: Room ATC203C
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