Bridges from School to Work Inquiry Form

Inquiry Form

Please fill out this form if you are interested in Bridges from School to Work.
Today's date

Month Day Year
Date
Select a Bridges city from the list below. *
What NYC borough>
Personal Information
Full Name *

First Name Last Name
How old are you?
E-mail (please enter twice to verify accuracy.) *

Confirmation Email example@example.com
City of residence?
Zip code?
Phone Number *
Do you agree to receive text messages at this number about events, news, and updates? Note that message and data rates may apply. *

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Alternate phone number?
What is the name of the high school you attend or attended? *
Check any and all items below that apply to you:

I am still in high school. I have graduated from high school. I am in technical school, trade school, or college I am not in high school, technical school, or college.
If you are still in high school, please check one of the following:

I am a high school senior. I am a high school freshman, sophomore, or junior. Other
If you have graduated from high school, please enter the year of your graduation.
Please choose one of the following

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Check all that apply. *

American Indian or Alaska native Asian Black or African American Hispanic/Latino Native Hawaiian or Pacific Islander White Don't know Choose not to answer Other
How did you hear about Bridges? *

Teacher Vocational rehabilitation counselor A Bridges representative visited my school Internet Search or from the Bridges website Other
Do you (or did you) have an IEP or 504 Plan and receive special education services? *

Yes No Not sure
Thank you for filling out this form. Someone will be in contact with you by phone or email.
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Inquiry Form

Personal Information