All fields mark with * is required

Name of Employee:* Date:

School and Grade:*  

Worksite:*  

1. What have you learned at your Lighthouse work site since employment began?*

2.Please describe your daily job responsibilities?*

3. Did the Lighthouse Coordinator put you with a class and teacher you enjoy working with?*
Yes No

If not explain:

4. How would you rate your work experience?*
Excellent Above Average Average Below Average

5. What kinds of future training would be beneficial to you?*

6.Do you plan on attending college?
Yes No

7.Do you need additional information or help with a college application?
Yes No