Exit Student/Program Admin/Instructor Course Review Survey Thank you for your interest in reviewing Charlie Academy Life and Leadership courses. Question Title * 1. Contact Name School City/Town State/Province Country Email Address Phone Number Question Title * 2. I am a Student. School grade completed: High School Junior High School Senior College Freshman College Sophomore College Junior College Senior Graduate Student Other: Question Title * 3. Do you represent a vulnerable population?* Vulnerable Population includes those economically disadvantaged, racial and ethnic minorities, the uninsured, low-income children, homeless, those with disabilities, mental illness, or chronically ill. Yes No Question Title * 4. I am a Program Administrator/Instructor: Program Administrator Program Instructor Professor Other Question Title * 5. Please describe your race/ethnicity. Question Title * 6. Would you be interested in reviewing one or more Charlie Life and Leadership Academy courses? If yes, we will be in contact with you and appreciate your willingness to share your insights, ideas, and feedback. Yes No Question Title * 7. Would you be interested in providing a quote (or two):Quote Option 1:Endorsing Charlie Academy's vision and intent to provide online leadership education for students? And/or:Quote Option 2: A general quote on the vital need for students to learn leadership skills to succeed in school, work, and life? If so, please consider drafting one or both quotes below. Thank you for your support! Question Title * 8. I think our school/institution would be interested in being a beta test site for Charlie Academy. Yes No Maybe Done