First name

Last name

Age

Email

Phone

College (if none, write none)

Do you work? Yes No

How many hours do you work per week?

Do/did you intend to get an associate's degree, a transfer, or a certificate? Yes No

Tell us your story in the box below.

What is your "day in the life" like?
Do you have enough time to study?
How do you fit it in?
What would you do with an extra 10 hours a week to spend on school?
What is the most difficult thing about working and going to school at the same time?

Would you share your story with the media? Yes No

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