GRADUATE ALUMNI SURVEY-2013 Full-Time Graduates

1. Education Program Evaluation-Part 1

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* Please complete the following:

Name: *

Address: *

City/Town: *

State: *

ZIP: *

Email Address:

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* Have you taken the NCLEX-PN Exam?

Yes

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* Date of NCLEX-PN

Date of NCLEX

Date

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* NCLEX Results

	Pass	Fail
NCLEX-PN Results	NCLEX-PN Results Pass	NCLEX-PN Results Fail

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* Current Employer:

Company:

Address:

City/Town:

State:

ZIP:

Job Title/Position:

Shift:

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* Date of Employment

Start Date

Date

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* Status:

Full-Time

Part-Time

Casual

Per Diem:

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* Starting Wage:

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* Current Wage:

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* Major Area of Practice:

Medical Surgical

Surgical Nursing

Maternity

Pediatrics

Geriatrics/LTC

Home Nursing

Office Nursing

Hospice Nursing

Rehab Nursing

Emergency Nursing

Traditional Care

Prison Nursing

Other (Specify Below)

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* Other (Specify):

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* Indicate Highest position held since graduation:

Charge Nurse

Staff Nurse

Other (Specify Below)

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* Other (Specify):

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* Name and address of other employers since graduation.

Employer:

Address:

City/Town:

State:

ZIP:

Dates of Employment:

Position:

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* Reason for leaving

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* Name and address of other employers since graduation.

Employer:

Address:

City/Town:

State:

ZIP:

Dates of Employment:

Position:

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* Reason for leaving

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* Reasons for leaving employer since initial employment following graduation:

Education

Working Conditions

Family

Monetary

Change of Vocational Interest

Other (Specify Below)