AEL ITEC FORM Name* FIRST NAME MIDDLE INITIAL LAST NAME DATE OF BIRTH* Month Day Year LOCAL PHONE NUMBEREmail* EDUCATION INFORMATIONHigh School Diploma/Equivalent: Yes No If yes, year obtained: GED Sections Completed: Yes No If yes, sections completed: Training Course: Yes No Certificate Program: Yes No College: Yes No If YES, name of institution: Degree Associates Bachelors Masters EMPLOYMENT INFORMATIONEmployed: Yes No If employed, how many hours a week? Workforce Solution Referrals Yes No Workforce Solutions Office: Are you actively looking for work? Yes No AEL Course Enrollment: ABE ASE IET ESL Civics Other: Others Student Signature:*Date MM slash DD slash YYYY 1. LONG TERM GOALS: Educational, career, or personal goals I hope to accomplish within the next 3-5 years?1.1 Specific GoalSteps I need to take to achieve my goalI hope to achieve this goal by: (month/year)2. LONG TERM GOALS: Educational, career, or personal goals I hope to accomplish within the next 3-5 years?2.1 Specific GoalSteps I need to take to achieve my goalI hope to achieve this goal by: (month/year)3. LONG TERM GOALS: Educational, career, or personal goals I hope to accomplish within the next 3-5 years?3.1 Specific GoalSteps I need to take to achieve my goalI hope to achieve this goal by: (month/year)4. LONG TERM GOALS: Educational, career, or personal goals I hope to accomplish within the next 3-5 years?4.1 Specific GoalSteps I need to take to achieve my goalI hope to achieve this goal by: (month/year)5. LONG TERM GOALS: Educational, career, or personal goals I hope to accomplish within the next 3-5 years?5.1 Specific GoalSteps I need to take to achieve my goalI hope to achieve this goal by: (month/year)1. SHORT TERM GOALS: These are objectives I hope to accomplish within the next year.1.1 SPECIFIC OBJECTIVES: Educational objectives as well as goals related to training, employment or personal long term goals 1.2 How will objectives be measured? 1.3 Date 1.4 Document progress toward objectives. Circle: A (Achieved objective), P (Progress made), M (Modified objective) A (Achieved objective) P (Progress made) M (Modified objective) 2. SHORT TERM GOALS: These are objectives I hope to accomplish within the next year.2.1 SPECIFIC OBJECTIVES: Educational objectives as well as goals related to training, employment or personal long term goals 2.2 How will objectives be measured? 2.3 Date 2.4 Document progress toward objectives. Circle: A (Achieved objective), P (Progress made), M (Modified objective) A (Achieved objective) P (Progress made) M (Modified objective) 3. SHORT TERM GOALS: These are objectives I hope to accomplish within the next year.3.1 SPECIFIC OBJECTIVES: Educational objectives as well as goals related to training, employment or personal long term goals 3.2 How will objectives be measured? 3.3 Date 3.4 Document progress toward objectives. Circle: A (Achieved objective), P (Progress made), M (Modified objective) A (Achieved objective) P (Progress made) M (Modified objective) 4. SHORT TERM GOALS: These are objectives I hope to accomplish within the next year.4.1 SPECIFIC OBJECTIVES: Educational objectives as well as goals related to training, employment or personal long term goals 4.2 How will objectives be measured? 4.3 Date 4.4 Document progress toward objectives. Circle: A (Achieved objective), P (Progress made), M (Modified objective) A (Achieved objective) P (Progress made) M (Modified objective) 5. SHORT TERM GOALS: These are objectives I hope to accomplish within the next year.5.1 SPECIFIC OBJECTIVES: Educational objectives as well as goals related to training, employment or personal long term goals 5.2 How will objectives be measured? 5.3 Date 5.4 Document progress toward objectives. Circle: A (Achieved objective), P (Progress made), M (Modified objective) A (Achieved objective) P (Progress made) M (Modified objective) List Career Counseling Services Needed (such as resume, interest inventory, job search, and interview skills): List Potential Barriers to your Individual Training, Education, and Career Plan (such as childcare, transportation, work schedule, school schedule, criminal background): NameThis field is for validation purposes and should be left unchanged.
