Family Exit Survey

Question Title

* 1. Which building(s) did your child(ren) attend?

Boulevard

Canterbury

Fairfax

Gearity

Heights High

Monticello

Noble

Options

Oxford

Roxboro Elementary

Roxboro Middle

Other (please specify)

Question Title

* 2. What grade level(s) are your children currently in?

Kindergarten

Question Title

* 3. What is your primary reason for leaving the school district?

Moving out of district

Ed Choice Scholarship Program

Private school

Home schooling

Family status change (divorce, separation, death)

Change of job status

Student being unsuccessful in current educational environment

Jon Peterson Special Needs Scholarship Program

Family medical issue

Academic programming

Programming for students with special needs

Transportation issues

Safety and security

Other (please specify)

Question Title

* 4. Rate your satisfaction with the following:

	Low				High
Academic programs	Academic programs Low	Academic programs	Academic programs	Academic programs	Academic programs High
Special education programs	Special education programs Low	Special education programs	Special education programs	Special education programs	Special education programs High
Extracurricular programs	Extracurricular programs Low	Extracurricular programs	Extracurricular programs	Extracurricular programs	Extracurricular programs High
Athletics	Athletics Low	Athletics	Athletics	Athletics	Athletics High
Level of diversity	Level of diversity Low	Level of diversity	Level of diversity	Level of diversity	Level of diversity High
Attendance policy	Attendance policy Low	Attendance policy	Attendance policy	Attendance policy	Attendance policy High
Discipline	Discipline Low	Discipline	Discipline	Discipline	Discipline High
Communication from the school	Communication from the school Low	Communication from the school	Communication from the school	Communication from the school	Communication from the school High
School administration	School administration Low	School administration	School administration	School administration	School administration High
Teachers	Teachers Low	Teachers	Teachers	Teachers	Teachers High
Other school staff	Other school staff Low	Other school staff	Other school staff	Other school staff	Other school staff High
Parent-teacher relationships	Parent-teacher relationships Low	Parent-teacher relationships	Parent-teacher relationships	Parent-teacher relationships	Parent-teacher relationships High
Safety and security	Safety and security Low	Safety and security	Safety and security	Safety and security	Safety and security High

Question Title

* 5. Now that you have experienced our school district, how would you describe the CH-UH City Schools to a friend or neighbor?

Question Title

* 6. Please give us specific suggestions for how we could improve our school district for the children in Cleveland Heights-University Heights.

Question Title

* 7. We may wish to follow up with you to learn more about your family's experiences in our district. Please provide your information if you'd like to be contacted (this is optional).

Name

Email Address

Phone Number

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* 8. Please select your race designation(s) below. This is optional.

White or Caucasian

Black or African American

Asian or Asian American

Native Hawaiian or other Pacific Islander

Hispanic or Latino

American Indian or Alaska Native

Multiracial

Other (please specify)