Student Name: Last, First

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* 1. Student Name: Last, First

Grade

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* 2. Grade

School

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* 3. School

Last Date Attended

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* 4. Last Date Attended

Number of years your student attended MTSD

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* 5. Number of years your student attended MTSD

Why are you leaving the Mequon-Thiensville School District?

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* 6. Why are you leaving the Mequon-Thiensville School District?

What did you enjoy most about the Mequon-Thiensville School District?

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* 7. What did you enjoy most about the Mequon-Thiensville School District?

What should the district focus its continuous improvement efforts on in order to improve service?

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* 8. What should the district focus its continuous improvement efforts on in order to improve service?

On a scale of 1-5, how would you rate your overall experience in MTSD?

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* 9. On a scale of 1-5, how would you rate your overall experience in MTSD?

Additional comments or feedback:

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* 10. Additional comments or feedback:

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