Local to the Cedar Valley

A few questions so we can get to know you.

Momentum is six weeks. This part takes about ten minutes. Name and phone are the only must-haves — the rest is optional, and there are no wrong answers.

1 of 3

Who are you

First name

Last name

Address

Phone

Gender

Race/Ethnicity

Are you a U.S. Veteran?

2 of 3

A little about work

What kinds of jobs are you looking for? Are you interested in an internship?

Where have you applied to work in the last 2 weeks? If not, why?

Is there anything physically or legally prohibiting you from employment?

When was the last time you worked? Where?

3 of 3

Almost done

Do you have your driver’s license?

Anything else you’re plugged into right now? Church, DOC education, treatment, recovery groups…

How did you hear about Momentum?

What drives you to be successful? What would cause you to make it six weeks?

Name and phone are the only required fields.