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Interested in Participating?

If you or a loved one could benefit from participating in Employ 210, please fill out the form below. This is for our general interest list where we can let you know about upcoming opportunities. Please visit our Events section to view current job trainings available.

Participant Name

What is your relation to the participant?

Filling out form for myself

Filling out form for my child (caregiver)

Filling out form for my client (WIN counselor)

Filling out form for my student (teacher)

Other

Please describe "other"

Participant Contact Number

Email

What is the best way for Employ 210 to contact the participant? *

Text

Email

Phone Call

Other

Please describe "other"

Is there someone you want CC'd or included in our communications with the participant? E.g., parent, guardian, partner, etc. If yes, please provide their information below

How did you hear about Employ 210? *

MAC Navigator

WIN Counselor

Texas Workforce Counselor

Social Media

Friend / caregiver / word of mouth

Community Event

Other

Please describe "other"

Gender *

Male

Female

Non-binary / Third Gender

Prefer not to say

What are the participant's pronouns? *

He / Him

She / Her

They / Them

Prefer not to say

Other

Please describe "other"

How old are you?

What is your zip code?

What ethnicity do you identify as? *

Asian or Asian American

Black or African American

Hispanic / Latino

White or Caucasian

Other

Please describe "other"

In order to be eligible for our training, you must have a diagnosed neurodevelopmental disability/delay which impacts your daily activities or the work you can do. Examples: Autism, ADHD/ADD, ID, TBI, CP, Learning Disability, Tourettes, etc. Please plan to provide the following documentation at our intake appointment: *

SSI or SSDI Award Letter

Education Record

Medical Document

Which of these is currenly MOST applicable to you? *

Self-employed

Paid Employment

Unemployed

Long-term Sick

Volunteer Work

Other

Please describe "other"

How many hours do you work at your primary job/business each week?

What is your hourly wage at your primary job/business? If not applicable, write N/A.

Are you a member with Morgan's Multi-Assistance Center (MAC)?

No

Yes

Yes, may navigator is:

Are you current recieving any employment counseling or benefits? *

Not Sure

No

Yes

If yes, please describe below.

What is your highest degree of education you have obtained? *

High school diploma or equivalent

Some college or post secondary education

Associates degree

Bachelor degree

Masters or doctoral degree

Other

Please describe "other"

In the past 12 months were you enrolled on a full-time or part-time education course studying for any qualification even if you did not obtain them? *

Yes

No

What would be your dream job/occupation if there were no barriers to employment?

Dream job category *

Arts

Business

Communication

Education

Healthcare

Hospitality

Information Technology

Law Enforcement

Sales and Marketing

Science

Transportation

Other

Please describe "other"

What is your preferred work environment? * Required

Collaborative

Independent role

Fast-paced

Slow-paced

Structured / corporate

Unstructured / flexible

Customer-facing

Behind the scenes

Other

Please describe "other"

Do you have any barriers to employment? * Required

Application assistance

Interview prep

Assistance with reume and cover letter

Need computer training

Job search

Transportation

Other

Please describe "other"

What skills do you possess that you think would make you a good candidate for employment?

List any accommodations you may need: * Required

Mobility concerns

Communication barriers

Social skills difficulty

Memory issues

Difficulty learning new tasks

Difficulty focusing

Other

Please describe "other"

List any accommodations you may need: What does transportation look like for you? * Required

Drives self

Utilizes rideshare (e.g., VIA trans, bus, Uber, Lyft, etc.)

Relies on transportation from family, friends, etc.

Other

Please describe "other"

Thank you for your submission. Please allow up to 48 hours for a response.

Join our mailing list

Email*

Employ 210 is a research service grant project awarded to the University of Texas at San Antonio, funded by the United States Department of Education Office of Special Education and Rehabilitation Services Disability Innovation Fund (PI:Davis).

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