LEARNING NEEDS SCREENING
CLIENT COPY

How many years or schooling have you had?

Check all earned:

• High School Diploma
• GED
• Technical/Vocational Certificate
• Other (specify):

What kind of job would you like to get?

Do you have any experience in this area?

What makes it hard for you to get or keep this kind of job?

What would help?

The following questions are about your school and life experiences. We're trying to find out how it was for you (or your family members) when you were in school or how some of these issues might affect your life now. Your responses to these questions will help identify resources and services you might need to be successful securing employment.

1. Did you have any problems learning in middle school or junior high school?
2. Do any family members have learning problems?
3. Do you have difficulty working with numbers in columns?
4. Do you have trouble judging distances?