Fomu ya Usajili wa Mwanafunzi
Page 1
Maelekezo: Tafadhali kamilisha sehemu zote zilizo hapa chini.
Maelezo ya Mwanafunzi
La Kwanza Jina:
La Kati:
La Mwisho:
Tarehe ya Kuzaliwa
Mwezi:
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Siku:
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Mwaka:
Je, kwa sasa unaishi katika Jimbo la Indiana nchini Marekani?
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Ndiyo
Hapana
Shirika la Indy Reads linawahudumia wanafunzi wenye umri mkubwa katika jimbo la Indiana. Tafadhali taja nchi yako, na panapohitajika, jimbo na jiji lako hapa chini. Maelezo unayotoa yatatumiwa kama data ya kuchunguza uwezekano wa kueneza mpango wetu katika maeneo mengine. Asante!
Nchi Yako
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Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo, Republic of(Brazzaville)
Cook Islands
Costa Rica
Côte D'ivoire (Ivory Coast)
Croatia
Cuba
Cyprus
Czech Republic
Democratic Republic of the Congo (Kinshasa)
Denmark
Djibouti
Dominica
Dominican Republic
East Timor (Timor-Leste)
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Great Britain
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran (Islamic Republic of)
Iraq
Ireland
Israel
Italy
Ivory Coast
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Rep. (North Korea)
Korea, Republic of (South Korea)
Kosovo
Kuwait
Kyrgyzstan
Lao, People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia, Rep. of
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federal States of
Moldova, Republic of
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar, Burma
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian territories
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Island
Poland
Portugal
Puerto Rico
Qatar
Reunion Island
Romania
Russian Federation
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia (Slovak Republic)
Slovenia
Solomon Islands
Somalia
South Africa
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria, Syrian Arab Republic
Taiwan (Republic of China)
Tajikistan
Tanzania; officially the United Republic of Tanzania
Thailand
Tibet
Timor-Leste (East Timor)
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City State (Holy See)
Venezuela
Vietnam
Virgin Islands (British)
Virgin Islands (U.S.)
Wallis and Futuna Islands
Western Sahara
Yemen
Zambia
Zimbabwe
Jimbo Lako
Please select...
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Jiji Lako
Nambari ya Ruzuku ya Serikali (hiari):
Anwani ya Mtaa:
Jiji:
Jimbo:
Msimbo wa Eneo:
Jinsia:
Nambari ya Simu:
Barua pepe:
Nchi ya Asili:
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Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo, Republic of(Brazzaville)
Cook Islands
Costa Rica
Côte D'ivoire (Ivory Coast)
Croatia
Cuba
Cyprus
Czech Republic
Democratic Republic of the Congo (Kinshasa)
Denmark
Djibouti
Dominica
Dominican Republic
East Timor (Timor-Leste)
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Great Britain
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran (Islamic Republic of)
Iraq
Ireland
Israel
Italy
Ivory Coast
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Rep. (North Korea)
Korea, Republic of (South Korea)
Kosovo
Kuwait
Kyrgyzstan
Lao, People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia, Rep. of
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federal States of
Moldova, Republic of
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar, Burma
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian territories
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Island
Poland
Portugal
Puerto Rico
Qatar
Reunion Island
Romania
Russian Federation
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia (Slovak Republic)
Slovenia
Solomon Islands
Somalia
South Africa
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria, Syrian Arab Republic
Taiwan (Republic of China)
Tajikistan
Tanzania; officially the United Republic of Tanzania
Thailand
Tibet
Timor-Leste (East Timor)
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City State (Holy See)
Venezuela
Vietnam
Virgin Islands (British)
Virgin Islands (U.S.)
Wallis and Futuna Islands
Western Sahara
Yemen
Zambia
Zimbabwe
Lugha za Asili:
Ni lugha gani unayozungumza sana nyumbani?
Kabila:
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Mhispania (Mtu ambaye utamaduni au asili yake ni ya Cuba, Mexico, Puerto Rico, Amerika ya Kusini au Amerika ya Kati, au Hispania, bila kujali mbari)
Sio Muhispania
Mbari:
Mweusi au Mwafrika Mmarekani
Mmarekani Mhindi
Mwasia
Mwanakisiwa wa Pasifiki
Mzungu
Wahispania tu
Hali ya Ajira:
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Nimeajiriwa (Nina kazi.)
Ninatafuta Kazi (Ninahitaji kazi mpya.)
Siko katika Nguvu Kazi (Sihitaji kazi.)
Mwajiri (je, unamfanyia nani kazi?):
Cheo cha Kazi:
Tarehe ya Kuanza (je, ulianza kufanya kazi lini huko?):
Je, unafanya kazi ya kudumu? (Saa 35 au zaidi kwa wiki):
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Ndiyo
Hapana
Je, unafnaya kazi muda maalum? (Saa 0-35 kwa wiki)
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Ndiyo
Hapana
Je, ni manufaa gani unayopokea?
SNAP
Medicaid
Ulemavu wa Ruzuku ya Serikali
HIP Plus (2.0)
TANF
Nyingine
Hamna
Nyingine:
Je, unapata au kupokea pesa?
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Ndiyo
Hapana
Je, ni mara ngapi unapata au kupokea pesa?
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Mara moja kwa wiki
Kila baada ya wiki mbili
Mara moja kwa mwezi
Kiasi gani?
Je, wewe au watu wengine wazima katika nyumba yako wanapata chini ya $1,600 kwa mwezi?
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Ndiyo
Hapana
Je, watu wengine wazima katika nyumba yako wanapata au kupokea pesa?
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Ndiyo
Hapana
Je, ni mara ngapi unapata au kupokea pesa?
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Mara moja kwa wiki
Kila baada ya wiki mbili
Mara moja kwa mwezi
Kiasi gani?
Kiwango cha Elimu
Je, kiwango chako cha elimu ni gani? Ulisoma kwa miaka mingapi?
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Sijasoma
Gredi 1-5
Gredi 6-8
Gredi 9-12 (sina diploma)
Diploma ya Shule ya Upili/Cheti Mbadala
GED/HSE
Chuo kidogo, sina shahada
Shahada ya Ushiriki
Shahada ya Kwanza
Zaidi ya Shahada ya Kwanza
Haijulikani
Sekta ya Digrii:
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Ujuzi wa Biashara
Biashara, Udhibiti na Usimamizi
Elimu na Mafunzo
Sayansi ya Afya
Teknolojia ya Habari
Utengenezaji wa Bidhaa
Uchukuzi, Usambazaji na Mipango ya Shughuli
Nyingine
Nyingine
Diploma ya Shule ya Upili/Cheti Mbadala; Mwaka
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GED/HSE; Mwaka:
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Je, unasoma sasa hivi?
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Ndiyo
Hapana
Ikiwa ndiyo, wapi?
Je, una umri wa miaka 16-18, lakini huendi shuleni?
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Ndiyo
Hapana
Je, wewe ni mzazi wa kukaa nyumbani asiye na makao? (Je, familia yako ilipoteza mapato hivi majuzi?):
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Ndiyo
Hapana
Je, wewe ni mzazi ambaye huna mume au mke?
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Ndiyo
Hapana
Je, ulipoteza kazi hivi majuzi?
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Ndiyo
Hapana
Ikiwa ndiyo, kwa nini?
Je, una watoto walio chini ya miaka 18?
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Ndiyo
Hapana
Ikiwa ndiyo, orodhesha umri wa watoto wako wote:
Je, unapata huduma ya malezi kwa sasa?
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Ndiyo
Hapana
Je, wewe ni raia wa Marekani?
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Ndiyo
Hapana
Je, utamaduni na/au historia yako inakutatiza kupata kazi?
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Ndiyo
Hapana
Je, wewe ni Mfanyakazi wa Kilimo?
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Ndiyo
Hapana
Ikiwa ndiyo, ni mara ngapi unafanya kazi shambani?
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Mwaka Mzima
Sehemu ya Mwaka (Kimsimu)
Nyingine
Nyingine:
Je, uko katika Jeshi la Marekani kwa sasa?
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Ndiyo
Hapana
Je, mwanandoa wako yuko katika Jeshi la Marekani?
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Ndiyo
Hapana
Je, wewe Ni Askari Mstaafu? (Je, ulikuwa katika Jeshi la Marekani awali?)
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Ndiyo
Hapana
Je mwanandoa wako ni Askari Mstaafu?
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Ndiyo
Hapana
Je, uko kwenye Vocational Rehabilitation Program?
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Ndiyo
Hapana
Ikiwa ndiyo, wapi?
Je, uko kwenye Vocational Rehabilitation and Education Program?
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Ndiyo
Hapana
Ikiwa ndiyo, wapi?
Je, una maradhi yoyote mabaya yanayoweza kuzuia mahudhurio yako ya darasa?
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Ndiyo
Hapana
Je, una changamoto au ulemavu wowote wa masomo?
Kutoweza kusoma vizuri
ADHD
Skizofrenia
Elimu Maalum/Mahitaji Maalum
Kuona
Kusikia
Hamna
Nyingine
Nyingine
Je, hali yako ya maisha ni gani?
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Muda Mrefu (kupangisha au kumiliki)
Muda Mfupi
Je, umekuwa katika makao ya muda mfupi kwa muda gani?
Muda Mfupi
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Makao ya Mpito
Dhamira
Makao ya Kundi
Hifadhi ya Kukosa Makao
Nyingine
Hamna
Nyingine
Je, Hadhi yako ya Ndoa ni gani?
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Mwenzi katika Ndoa
Nimetalikiwa
Mwenzi wa Nyumbani
Nimeoa/Nimeolewa
Tumetengana
Sina Mume/Mke
Mjane
Je, unatumia usafiri gani?
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Ninamiliki na kuendesha gari
Ninasafiri na rafiki au mwanafamilia
Ninasafiri kwa basi (usafiri wa umma)
Teksi/Uber/Lyft
Nyingine
Nyingine
Hali ya Mfungwa wa Zamani
Je, umewahi kufungwa kwa kosa la jinai?
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Ndiyo
Hapana
Ikiwa ndiyo, mwaka gani?:
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2020
2019
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Sentensi:
Je, umewahi kufungwa kwa kosa dogo?
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Ndiyo
Hapana
Ikiwa ndiyo, mwaka gani?:
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2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
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2004
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2002
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Sentensi:
Je, umepokea vikwazo vya agizo la mahakama kwa sasa? (Mfano: Kifungo cha Nyumbani, ouse Arrest, Kiungo cha Kazini, n.k.)
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Ndiyo
Hapana
Hali ya Mfungwa wa Zamani
Je, umepata usaidizi wa Matumizi ya Mihadarati ndani ya mwaka uliopita?
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Ndiyo
Hapana
Have you gotten help for Mental Health within the past year?
(In-Patient or Out-Patient treatments, Therapy, Medications, etc.)
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Ndiyo
Hapana
Date of Birth
Contact Record Type ID
Page 2
Malengo
Je, unataka kazi mpya?
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Ndiyo
Hapana
Je, unataka kupata diploma yako ya HSE?
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Ndiyo
Hapana
Je, unataka kuenda kwenye chuo/chuo kkuu?
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Ndiyo
Hapana
Je, unataka kufanya kozi au mafunzo ya cheti cha kazi?
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Ndiyo
Hapana
Je, unataka kumsaidia mtoto wako kwa zoezi lake la ziada zaidi?
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Ndiyo
Hapana
Je, unataka kuhusika zaidi katika jamii yako?
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Ndiyo
Hapana
Je, unataka kuwa na fedha za kutosha na kuacha usaidizi waumma?
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Ndiyo
Hapana
Contact Information