Opportunity R3 Pre-registration Survey Name *First Name, Middle Initial, Last NameAge *Gender *FemaleFemaleMaleOtherDate of Birth *Street AddressApartment, suite, etcCityState/ProvinceZIP / Postal CodeEmail Address *Phone *T-Shirt SizeXSSMLXLXXLWhich of the following best describes you?U.S. CitizenRefugeePermanent residentOtherAre you currently enrolled in school? *YesNoAre you currently working? *YesNoAre you a resident of Shelby County? *YesNoWhich describes your current mode of transportation? *I have a VEHICLE that I drive.I can call on FRIENDS AND FAMILY that have a VEHICLE.I ride the BUS frequently.I use ride share like UBER and LYFT.I WALK wherever I need to go.Which form of identification do you have? *Driver's LicenseState IDNoneDo you have a bank account? *YesNoHave you ever been charged with a crime? *YesNoDo you have a history of substance abuse? *YesNoName two opportunities that you would like to take on a future career path. *Which form of education certification do you have? *High school DiplomaGEDCollege DegreeOtherWhat is keeping you from getting to any life goals right now? *Who is the most influential person in your life right now? *Below are the dates for upcoming sessions. Choose your #1 preference. *January 23- Feb 10February 27- March 17April 10- 28May 15- June 2Below are the dates for upcoming sessions. Choose your #2 preference. *January 23- Feb 10February 27- March 17April 10- 28May 15- June 2HTMLYou will receive a call within 72 hours following your submission of this registration survey. Please make sure that you have answered all questions honestly and accurately. If you are selected to move to the next round for registration, you will need to report to 555 Beale Street, Memphis, TN 38103 to complete other registration documents and meet with a talent development specialist. Congratulations on completing the 1st step and good luck to you. Your dream opportunity is almost within reach.Send Message
