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Exit Interview for Students
QSF-REG-040 (Rev 003 01/12/2015)
Please answer all questions. When completed and signed, click submit. All answers are kept confidential.
* Indicates required question
Email
*
Your email
Name
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Address
*
Your answer
Phone Number
Your answer
Mobile Number
*
Your answer
Email Address
*
Your answer
Course/Degree
*
Your answer
Date Admitted
*
MM
/
DD
/
YYYY
Exit Date
*
MM
/
DD
/
YYYY
Which of the following best describes your PRIMARY reason for leaving Southville?
*
Classes were not interesting/bored
Missed too many days and could not catch up
Failing classes
Became a parent
Felt like I did not belong
Student-teacher conflict
Migrate
Illness
Getting married
Family problems
Which of the following best describes your SECONDARY reason for leaving Southville?
*
Classes were not interesting/bored
Missed too many days and could not catch up
Failing classes
Became a parent
Felt like I did not belong
Student-teacher conflict
Migrate
Illness
Getting married
Family problems
What would have improved your chance of staying at Southville?
*
Opportunities for real world learning (internship)
Better teachers
More individualized instruction
Better communication with teachers
Better communication with parents
Increased parental involvement
Less freedom and more supervision from parents
Less freedom and more supervision from school officials
What actions did Southville personnel take to keep you here?
*
Provided student counseling
Scheduled a conference with parent(s), guardian(s), and school staff
Discussed and offered options for tutoring
Discussed the consequences of dropping out
Discussed and offered alternative options
Referred student to agencies/program to address problem
Tracked student progress (by teacher)
Changed or revised schedule
Student reported that school staff took no action
How would you rate the usefulness of your Educational preparation at Southville?
*
Helpful
1
2
3
4
5
Not Helpful
Which area of your education program at Southville were particularly strong ?
*
Your answer
Which areas of your educational program at Southville could be improved, if any?
*
Your answer
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