Participant Exit Survey High School

PARTICIPANT EXIT SURVEY HIGH SCHOOL

Thank you for your help with this important study. This survey includes questions about your family, friends, school, and also your attitudes and behaviors. Your name will not be on the survey and your responses will remain private to the extent permitted by law. We want you to know that:
1.
Your participation in this survey is voluntary.
2.
We hope that you will answer all of the questions, but you may skip any questions you do not wish to answer.
3.
The answers you give will be kept private to the extent permitted by law.

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* 1. What program are you a part of?

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* 2. How old are you?

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* 3. What grade are you in? (If you are currently on vacation or in summer school, indicate the grade you will be in when you go back to school.)
MARK ONLY ONE ANSWER

9th

10th

11th

12th

My school does not assign grade levels

I dropped out of school, and I am not working on getting a high school diploma or GED

I am working toward a GED

I have a high school diploma or GED but I am not currently enrolled in college or technical school

I have a high school diploma or GED and I am currently enrolled in college or technical school

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* 4. When you are at home or with your family, what language or languages do you usually speak?
MARK ALL THAT APPLY

English

Spanish

Other (please specify)

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* 5. Are you Hispanic or Latino?
MARK ONLY ONE ANSWER

Yes

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* 6. What is your race?
MARK ALL THAT APPLY

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or other Pacific Islander

White or Caucasian

Other (please specify)

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* 7. What is your sex?
MARK ONLY ONE ANSWER

Male

Female

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* 8. Are you currently......?
MARK ALL THAT APPLY

Living with family [parent(s), guardian, grandparents, or other relatives]

In foster care, living with a family

In foster care, living in a group home

Couch surfing or moving from home to home

Living outside, in a tent city or homeless camp, in a car, in an abandoned vehicle or in an abandoned building

Staying in an emergency shelter or transitional living program

Staying in a hotel or motel

In juvenile detention center, juvenile group home, and/or under the supervision of a probation officer

None of the above

Participant Exit Survey High School