Careers Uncomplicated

Name of person completing this form

First Name

Last Name

Prospective client's name (if different)

First Name

Last Name

Your relationship to the prospective client *

self

parent/guardian/other family member

referring professional

other

Client's pronouns (optional)

they/them

she/her

he/his

prefer not to specify

Your time zone

Eastern

Central

Mountain

Pacific

Outside of US

Phone

Best number to reach you for the exploratory call we'll schedule by email.

(###)

###

####

May we call or text you in addition to an email reply?

Email is the primary way we respond to inquiries, but we sometimes follow up with a text or phone call because occasionally our replies go into spam or are not received and we want to be sure you know we are not ignoring you! If your contacting us is confidential and private, you may prefer that we not text or call. Please let us know:

It is okay to text me and identify the text as from Careers Uncomplicated

It is okay to call or leave voicemail and identify the call as from Careers Uncomplicated

EMAIL ME ONLY

Your career level/situation

Please check all that apply for you or the person you're referring

High school student

College student

Recent college grad

Young professional (age 20s-early 30s, working or unemployed)

Other