Degrees Work Intake Form
is a FREE service to help adults find their way back to and through college. Congratulations on taking your first steps today toward reconnecting to college!
Please fill out as many of the questions below as possible so that we can serve you better, faster, and more effectively. Remember:
our services are always FREE. We will NEVER sell or give away your information.
This form may take you 5-10 minutes to complete, but it will allow us to immediately tailor advising services to you and other opportunities. After you submit the form, you will see a page with important information on next steps.
Thank you, and we look forward to assisting you,
The Degrees Work Advising Team
When do you want to start classes?
I'm Ready Today!
Within 3-6 Months
Within 6-12 Months
How quickly would you like to graduate?
Less than a Year
How did you hear about us?
Employer or Union
Faith Based Organization/House of Worship
Friend or Family Member
Poster or Billboard
Public School System, K-12
Referral from another service
Walked by Office
What is your most pressing issues?
Academic and study skills
Credit for Work & Life Experience
Managing Outstanding College Debt
Navigating Campus Resources
Online Courses, Tips, and Degree Options
Paying for College
Success With Returning to College
Time & Stress Management Strategies
Transferring College Courses & Credits
Where Do I Start?
Writing an Academic Essay
Preferred Contact Method
Phone or Email
What is your employment status?
Employed - 0 to 20 hours per week on average
Employed - 20 to 40 hours per week on average
Employed - 40+ hours per week on average
Not employed but looking
Not employed, not looking
Does your employer offer tuition benefits?
Current Job Title
The following information is considered confidential by many people. We are concerned with your privacy as well. Please know that this information is used only in aggregate, for fund-raising purposes, so that we may continue to provided our services for free. We appreciate your support as you consider providing the requested information.
Date of Birth
Hispanic, Latino or Spanish Origin
Black or African American
American Indian or Alaska Native
Middle Eastern or North African
Native Hawaiian or Other Pacific Islander
Some other race, ethnicity or origin
Gender you identify with
Alternative or Other
Please tell us a little about your educational experience.
What is the highest level of education you have completed?
Some College Credits Earned, No Degree
Associates Degree Completed
Associates Degree Earned Plus Credit Towards Bachelors Degree
Bachelors Degree Completed
Masters Degree Completed
Masters Degree Completed but No Bachelors Degree
Attained other Post-Secondary or Certification
What kept you from finishing a degree before?
Different Learning Abilities
Fear of Particular Academic Area
Fear of Failure
Lack of Adequate Support Systems
Unsure of Career Goals
Have you served in the US Armed Forces? (you might be eligible for several benefits)
What type of degree are you seeking?
Have 2-yr, seeking another 2-yr degree
Have 2-yr, seeking 4-yr degree
4 yr degree
Have 4-yr, seeking another 4-yr
Continuing Ed/Professional Development
Preferred class format (all that apply)
Combined - In person/Online
Academic Area of Interest
Arts, including Graphic Design
Human Resources Management/Organization Development
Psychology/Social Work/Human Services
What is your main reason for returning to college now?
Required by Employer
Interested in Increasing Earning Potential
Interested in Career Change
Interested in Obtaining a Better Job
By submitting this form I give permission to Degrees Work to forward my information to its partner institutions for purposes of assisting with my college admissions/enrollment.
I give permission to the Admissions/Office of Enrollment Management/Registrar of the College/University I shall be attending to release to Degrees Work verifying my enrollment status and my official transcript.
I fully understand that all information given on this application and information released to Degrees Work or its partner institutions is protected by the Federal Privacy Act and, therefore will be kept confidential. Degrees Work promises it will NEVER sell or give away personal information.
I certify that all information that I have provided on this application is accurate and true to the best of my knowledge and ability.
If you have questions now or later, please contact our staff: firstname.lastname@example.org or email@example.com or call 502-214-5406.
Need assistance with this form?