Michigan Works! Interest Form

*First Name

*Last Name

*Select the county in which you live.

*Zip Code

*Email Address

Phone Number (optional)

*What is your preferred method of contact? Email Phone call

*I would like to: Schedule a 1-on-1 appointment Be contacted for additional assistance

Would you like your scheduled appointment to be in-person or online? In-person Online (virtual appointment)

I'm interested in... (select all that apply) Earning more money Finding a new job Learning new skills Receiving better benefits Receiving career support

I would like the following career support... (select all that apply) Access to computers Help writing my resume Help with my career search Interview preparation Help finding funding for education/training Help finding childcare Veteran-specific career assistance

*How did you hear about Michigan Works!? (select all that apply) Social Media (e.g., Facebook, Instagram, X) Digital Advertisement Search Engine (e.g., Bing, Google, Yahoo) Website Email/Newsletter TV Radio Print Ad, Flyer, or Brochure Friend/Family Member Event/Job Fair None of the Above

Do you have additional needs, comments, or questions?

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