Student Exit Survey
Date *
MM
/
DD
/
YYYY
Grade Level *
First Name *
Your answer
Last Name *
Your answer
Email Address *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Home Phone *
Your answer
Cell Phone *
Your answer
Home School *
Program Area *
Facebook Name *
If none, enter "none"
Your answer
WORK EXPERIENCE
If you are working now, please provide the following information:
Business/Employer Name
Your answer
Address, City, State, Zip
Your answer
Supervisor's Name
Your answer
Job Title or Type of Work
Your answer
Phone #
Your answer
Date Job Began
MM
/
DD
/
YYYY
Wage Per Hour
Your answer
FUTURE PLANS
Do you plan to go straight into the workforce after graduation?
Business/Employer Name (after graduation)
Your answer
Address, City, State, Zip (after graduation)
Your answer
Supervisor's Name (after graduation)
Your answer
Job Title or Type of Work (after graduation)
Your answer
Phone # (after graduation)
Your answer
Date Job Begins (after graduation)
MM
/
DD
/
YYYY
Wage per Hour (after graduation)
Your answer
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