1) I know what I am going to do after this training or coaching session.

Yes   No

2) I know what I want to be (career path). Yes   No

3) I plan to work for an employer, do volunteer work, or start a business.

Yes   No    Do Not Know

4) I plan to attend a trade school or job training center when I complete this  training or coaching session.    Yes   No

5) I plan to attend a community college, 4-year college, university, or graduate  school when I complete this training or coaching session. 

Yes   No

6) I am retired. I plan to enjoy my life doing various things when I complete this training or coaching session.

Yes   No

7) If your answer is yes to question 2, please complete the following statement: I want to become a   by the time I am years old.

Adult Client Information: (please complete)

Name					Position
Years of Experience		Age		Sex  Male   Female
Employer
City
State				Zip
E-mail				Telephone
African American    Asian   Caucasian    Hispanic Other

Please contact me as soon as possible regarding this matter.