Name *
Email *
Phone Number *
Address *
City *
State *
DACC ID Number
Major *
Select one N/A Undecided Accounting, Transfer Ag-Business Anthropology Art Automotive Accounting, Career Adult Education Biology Business & Information Systems, Transfer CDL Certified Nurse Assistant Chemistry College Preparation Computers/Information Systems Computers/Office Systems & Technologies Corporate & Community Education Criminal Justice Culinary Arts Drafting/CAD Early Childhood Education Echocardiography Economics, Transfer Electronics English/Communication/Journalism English, Developmental English as a Second Language Fire Science French GED Geography High School: Traditional Dual Credit High School: College Express High School Project Lead the Way High School: Middle College History Health Information Technology Health Education/Nutrition Horticulture/Floriculture/Landscaping Humanities Heating, Ventilation, Air Conditioning Journalism Literature Logistics Marketing/Management Math, Business & Technical Math, Developmental Mathematics Manufacturing Technology Medical Assistant Medical Technician Music Nursing/Practical Nursing/Nurse Assistant Physical Education/Fitness Center Philosophy/Ethics Physical Science/Physics Political Science Psychology Radiologic Technology Reading, Developmental Science, General Small Business Development Center Sociology Sonography Spanish Social/Oral Communication Welding Wind Technology
Expected Graduation Date *
Select one N/A Spring 21 Summer 21 Fall 21 Spring 22 Summer 22 Fall 22 Spring 23 Summer 23 Fall 23 Spring 24 Summer 24 Fall 24 Spring 25 Summer 25 Fall 25
Veteran Status *
Select one Not a Veteran Veteran Dependent of a Veteran Spouse of a Veteran
DACC Enrollment Status *
Select one Enrolled Not Enrolled Graduate High school Pending
Future Goals *
Select one Seeking part-time employment Seeking full-time employment Seeking college enrollment Transfer to four year institutions Currently employed Seeking internship Seeking apprenticeship Relocate Start own business
Barriers to Success
choice 1 *
Please Select an option None Supplies Housing Technology/assistance with technology Lack of employment Work clothing Transportation Childcare Disability
choice 2
Please Select an option None Supplies Housing Technology/assistance with technology Lack of employment Work clothing Transportation Childcare Disability
choice 3
Please Select an option None Supplies Housing Technology/assistance with technology Lack of employment Work clothing Transportation Childcare Disability
choice 4
Please Select an option None Supplies Housing Technology/assistance with technology Lack of employment Work clothing Transportation Childcare Disability
choice 5
Please Select an option None Supplies Housing Technology/assistance with technology Lack of employment Work clothing Transportation Childcare Disability
How did you hear?
choice1-how *
None Email Community member\organization DACC staff DACC faculty Peer
Please select up to three (3) occupational groups that best fit your desired job type and interest
choice1-job *
None Management/Business Computer & Math Architecture & Engineering Life, Physical & Social Sciences Legal Education and Teaching Healthcare Healthcare Support Staff Protective Services Food Preparations & Serving Related Building/Grounds Maintenance Personal Care & Services Office & Administrative Support Manufacturing/Production Construction & Extraction Installation, Maintenance, & Repair Transportation & Material Moving Military Specific Other
choice2-job
None Management/Business Computer & Math Architecture & Engineering Life, Physical & Social Sciences Legal Education and Teaching Healthcare Healthcare Support Staff Protective Services Food Preparations & Serving Related Building/Grounds Maintenance Personal Care & Services Office & Administrative Support Manufacturing/Production Construction & Extraction Installation, Maintenance, & Repair Transportation & Material Moving Military Specific Other
choice3-job
None Management/Business Computer & Math Architecture & Engineering Life, Physical & Social Sciences Legal Education and Teaching Healthcare Healthcare Support Staff Protective Services Food Preparations & Serving Related Building/Grounds Maintenance Personal Care & Services Office & Administrative Support Manufacturing/Production Construction & Extraction Installation, Maintenance, & Repair Transportation & Material Moving Military Specific Other
Other text area
Please share your future employment plans and specific jobs you're looking for *