George Jackson University

ENROLLMENT FORM/QUESTIONNAIRE

Please fill out this Questionnaire to enroll in the University. All of the information that we receive we keep confidential. If at any time we want or desire to share any information you have submitted, we will be sure to ask you first for permission.

1. What is your name?
2. What name do you like to go by?
3. What is your age?
4. What is your birthdate?
5. Do you have any children?
6. If you answered yes to question five, how many?
7. What was your conviction?
8. How long have you been incarcerated?
9. What is your projected or most accurate release date, if any? If uncertain or none please state your status.
10. What city do you plan on living in once you are released?
11. What city would you like to live in upon your release?
12. Are you open to the idea of traveling?
13. Would you like to travel?
14. Are you open to the idea of traveling internationally if you were/are not restricted?
15. Would you like to travel internationally if you were/are not restricted?
16. Do you like to write and read?
17. Do you like to draw or have any other artistic interest?
18. What are your hobbies and interest?
19. What skills and trades do you possess?
20. What skills and/or trades would you like to possess?
21. Would you like a job in the areas of your listed hobbies and interest?
22. Would you like a job in the areas of your listed skill or trade?
23. What type or what job would you like to have specifically?
24. Do you mind living and working with others or would you prefer to live and work alone?
25. What’s you most notable characteristic?
26. What’s a quality you most admire in a woman? If you are a woman, what’s a quality you most admire in a man?
27. What do you value most in your friends?
28. What’s your biggest flaw?
29. What’s your dream of happiness? Please give description in 50 words or more.
30. In what country would you like to live and why, if outside of North America.
31. Who are your heroes in real life (male or female)?
32. Who are your heroes in history (male or female)?
33. What is it that you dislike the most (Person, place, or thing)?
34. What historical figures do you dislike?
35. What natural gift would you like to possess?
36. How would you prefer to die?
37. Which vices do you give into the most?
38. What is your motto?
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George Jackson University

Long Live The Dragon

ENROLLMENT FORM/QUESTIONNAIRE

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