Graduate Attestation/Survey Form
By completing and submitting the form or authorizing the school official to complete it on you behalf, you agree with the information provided. Pleas note that you may be contacted by the Accrediting Commission of Careers Schools and Colleges (ACCSC) or a 3rd Party Accreditor.
GRADUATE'S FULL NAME *
Your answer
CURRENT MAILING/LOCATION ADDRESS *
Your answer
CURRENT PHONE NUMBER *
Your answer
CURRENT EMAIL ADDRESS *
Your answer
PROGRAM TAKEN *
Your answer
Graduation Year *
Your answer
Graduation Semester *
Work Status *
Have you worked in your chosen DEC field and received reimbursement since your graduation?
Required
DATE OF INITIAL EMPLOYMENT
Your answer
EMPLOYER - "Self" if you are working independently and skip down to "FREELANCE CUSTOMER LIST"
Your answer
POSITION TITLE
What is your current position? (i.e. stylist, truck driver, medical assistant, makeup artist, fabricator, etc.)
Your answer
JOB DUTIES
Your answer
EMPLOYER PHONE NUMBER
Please provide your employer's phone number.
Your answer
IMMEDIATE SUPERVISOR
Your answer
EMPLOYER ADDRESS
Your answer
EMPLOYER EMAIL ADDRESS
Your answer
EMPLOYER WEBSITE
Your answer
"FREELANCE CUSTOMER LIST"
If you replied to the above question as "Self", please list the last several paid projects with customer contact information. (Name, phone and email address)
Your answer
PROGRAM BENEFIT: *
I was able to benefit from the skills and knowledge learned in my program by: (check one)
Required
EMPLOYMENT CLASSIFICATION: *
My new or current position is a paid job that meets my employment goal through: (check one)
Required
COMPENSATION: *
Are you paid for your training related work (please answer 'yes' or 'no')
Full-Time/Part-Time: *
COMMISSION AND TIPS:
Please check ALL applicable:
Hourly Rate Range:
Please check ALL applicable:
Salary rate range:
Please check All Applicable:
If compensated as Self-Employed, please estimate annual compensation:
OR flat rate received per project:
Your answer
Can DEC's Career Services department offer you any assistance at this time? *
Please explain.
Your answer
By submitting you name below, you are verifing that the above answers are a true and accurate attestation of your employment. *
Your answer
DATE *
MM
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DD
/
YYYY
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