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WCCS Seal

Directions:
Please answer each question truthfully and to the best of your ability.
Also, please keep in mind all assessments will remain confidential.
According to State Law of Alabama any persons under of age of 18 cannot participate in this assessment.
Our program does not guarantee you a job however it will prepare you for future employment.
If you have any questions about the material please contact Ms. Rose at ebony.rose@wccs.edu.

1. Name & I.D.

2. Phone Number

3. Home Address

4. Date of Birth

5. Email Address

6. What is your gender?
Male
Female

7. What is your race/ethnicity?

African American
Native American
Caucasian
Hispanic
Asian
Other:

8. Are you over the age of 18?
Yes
No
(If no please do not continue)

18-25
26-35
36-45
46-over

9. High School

a. Number of years completed:

b. Did you graduate?
Yes or
No

c. Degree / diploma earned:

10. Do you have a GED?
Yes or
No

11. Have you ever worked before?
Yes or
No (If yes where)

12. What are your hobbies?

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George Corley Wallace State Community College (Wallace Community College Selma)
3000 Earl Goodwin Parkway   P.O. Box 2530   Selma, Alabama 36702-2530  
Phone: 334-876-9227
(c) 2014 Wallace Community College Selma

It is the official policy of the Alabama State Department of Education, including postsecondary institutions under the control of the Alabama Community College System and Board of Trustees, that no person in Alabama shall, on the grounds of race, color, handicap, sex, religion, marital status, creed national origin, or age, be denied the benefits of, or be subjected to discrimination under any program, activity, or employment.

George Corley Wallace State Community College (Wallace Community College Selma) is accredited by the Commission on Colleges, Southern Association of Colleges and Schools to award Associate in Arts, Associate in Science, and Associate in Applied Science Degrees. Contact the Commission on Colleges at 1866 Southern Lane, Decatur, Georgia 30033-4097 or call 404-679-4500 for questions about the status of Wallace Community College Selma.

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