Intake form

Name *

Email address *

What is your current employment status?

What type of job are you seeking?

Please select at least one option.

Full-time

Part-time

Temporary

Internship

Remote

What skills or qualifications do you possess?

Have you participated in any workforce training programs before?

What type of mental health support are you seeking?

Please select at least one option.

Counseling

Support groups

Therapy

Substance abuse support

What challenges do you anticipate in your reentry process?

Do you have any specific goals you would like to achieve during this program?

How did you hear about the rise group?

Which service or services are you interested in?

Please select at least one option.

Job resources

Workforce training

Mental health support

Additional questions or comments

The Rise Group