BCTCC Follow-Up Survey
I. GENERAL INFORMATION
1. Former Student's LAST Name *
Your answer
1. Former Student's FIRST Name *
Your answer
2. Street Address *
Your answer
2. City *
Your answer
2. State *
Your answer
2. Zip Code *
Your answer
3. Phone Number *
Your answer
4. Email *
Your answer
5. Birthdate (mm/dd/yy) *
Your answer
6. What year did you graduate or leave school? *
7. School District *
8. Ethnicity *
9. What is your disability (Please select all that apply) *
Required
10. What is your gender? *
Your answer
11. Currently, are you... *
12. When you were in high school, what did you plan to do after high school? *
13. If your plans for after graduation changed, why did they change? (Please check all that apply) *
Required
II. School or Training After High School
PLEASE NOTE:
If your plan after high school was to go right to work, please skip ahead to Part III (Work After High School)
1. What type of school or training are you attending or have you attended?
2. Name (up to three) schools or traiing programs that you are attending or have attended. (Please also specify major)
Your answer
3. What accommodations are you receiving or using - or have you received or used at any time after high school? (please check all that apply)
III. Work After High School
PLEASE NOTE:
If you have not held a job, please go to Section IV (Community Living)
1. How many paying jobs have you held since leaving high school?
2. If you have left or changed jobs, Why? (Please check all that Apply)
3. What type of work have you had? (Please check all that apply)
4. What is the job title of your curent (or most recent) job?
Your answer
5. What is the name of the company you work for (or most recently worked for)?
Your answer
6. What is your pay? If NOT currently working - what was your pay for your most recent job?
7. How did you get this job? (Choose all that apply)
IV. COMMUNITY LIVING
1. Where do you live? (Please choose all that apply)
2. What do you do in your free time? (Please check all that apply)
3. From what agencies have you received support? (Please check all that apply)
4. Are there any activites that you would like to be involved in that you are not?
Your answer
5. If you answered YES to Question 4, what are the reasons you are not involved in activities of interest to you?
Your answer
6. How do you get around for work or other activities? (Please check all that apply)
V. CLOSING QUESTIONS
1. What areas or parts of high school prepared you for your life after high school? (Please choose all that apply)
2. Are you registered to vote? *
3. Are you registered with the Selective Service System? *
4. Do you need more information in the following areas?
5. Berks County Transition Coordinating Council (BCTCC) is dedicated to improving transition services in Berks County. What suggestions do you have for better preparing youth for life after high school?
Your answer
6. List any goals or future plans that you want to share.
Your answer
7. THANK YOU so much for taking time to complete this survey. Your input is very important to us!
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