Focus Beyond Exit Questionnaire
Case Managers complete this form when a student exits Focus Beyond including reaching the age of 22 and taking their diploma. This includes: taking a diploma before age 22, 15 day drop, aging out/no diploma, and enrolling in other district/school.

Reminder if a student is a 15 day drop, Case Managers need to document multiple attempts in EdPlan to communicate with the student/family in case there are barriers that we can support.
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Name *
Student Age *
Gender
Ethnicity *
Required
Student's Primary Language *
Please list student's primary language.
Home Language *
Please list student's primary language.
What is student's status upon leaving Focus Beyond? *
Required
Enrollment Date @ Focus Beyond *
MM
/
DD
/
YYYY
Exiting Date  (Drop, take diploma, age out/no diploma, other district enrollment) *
MM
/
DD
/
YYYY
Has this student dropped and re-enrolled during their period of eligibility? *
Required
Is the student his/her own guardian? *
Required
At the time of exiting, did the student have any of the following home needs: *
Required
At the time of exit, was the student enrolled/registered in...? *
Please check check the boxes if the student is enrolled/registered for programs currently or starting in the next 3 months.
Required
What community support was the student receiving? *
Required
Was student connected to any self advocacy or recreation groups? *
(i.e. ARC, MCIL, Autism Society, Fraser, adaptive recreation, Friendship Club)
Required
Notes and Additional Information about exit
Case Manager *
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