AEL ITEC FORM Name* FIRST NAME MIDDLE INITIAL LAST NAME DATE OF BIRTH* MM DD YYYY LOCAL PHONE NUMBEREmail* EDUCATION INFORMATIONHigh School Diploma/Equivalent:YesNoIf yes, year obtained:GED Sections Completed:YesNoIf yes, sections completed:Training Course:YesNoCertificate Program:YesNoCollege:YesNoIf YES, name of institution:Degree Associates Bachelors Masters EMPLOYMENT INFORMATIONEmployed:YesNoIf employed, how many hours a week?Workforce Solution ReferralsYesNoWorkforce Solutions Office:Are you actively looking for work?YesNoAEL Course Enrollment: ABE ASE IET ESL Civics Other: OthersStudent Signature:*Date Date Format: 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 goals1.2 How will objectives be measured?1.3 Date1.4 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 goals2.2 How will objectives be measured?2.3 Date2.4 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 goals3.2 How will objectives be measured?3.3 Date3.4 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 goals4.2 How will objectives be measured?4.3 Date4.4 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 goals5.2 How will objectives be measured?5.3 Date5.4 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.
