First Name *

Last Name *

Phone Number *

Your Email *

Birthdate (mm/dd/yyyy) *

What city do you live in? *

Are you currently employed? * —Please choose an option—YesNo

If you are currently employed, do you work less than 20hrs per week? —Please choose an option—YesNo

How are your computer skills? * —Please choose an option—I could use some helpFairGood

Do you have a laptop or computer with microphone and camera capabilities?* —Please choose an option—YesNo

Do you identify as having a disability or long-term health issue? —Please choose an option—YesNoI'm not sure

Which Career Pathways program are you interested in?* —Please choose an option—Career Pathways - Persons with Disabilities KamloopsCareer Pathways - Persons with Disabilities KelownaCareer Pathways - Persons with Disabilities Vancouver

Where did you hear about this program? *
FacebookInstagramOnline Search (e.g. Google)Info Booth (e.g. at Starbucks)Radio / TVNewspaperWorkBCBrochure / PosterJob FairOther:

Do you have any other questions/comments for us?