Personal Information
Name:
E-mail Address
Phone Number
Are you married?
Yes
No
Engaged
Do you have children?
Yes
No
Expecting
Community College Information
If you did not attend Community College, skip these questions
After high school graduation, have you attended a Community College?
Yes
No
Which Community College(s) have you attended?
Are you currently enrolled in a Community College?
Yes
No
Did you transfer from a Community College to another 2 year or to a 4 year school?
2 Year
4 Year
No Transfer
If you did transfer to a 2 year or 4 year, which school did you attend?
4-Year College Information
If you did not attend a 4-year college, skip these questions
After high school graduation, have you attended a 4 year college?
Yes
No
What was the name of the 4 year college you attended?
Are you currently enrolled in a 4 year school?
Yes
No
Academic Information
Answer these questions if you have attended any form of Post Secondary Education
What was/is your GPA?
Above-3.8
3.7-3.4
3.3-3.0
2.9-2.5
2.4-2.1
2.1-below
Have you graduated with:
Associates Degree
Bachelors Degree
Certificate
Did not graduate
Other
If have not graduated, what year will you have completed at the end of the Spring Semester 2010 according to your number of credits and GPA?
1st Year
2nd Year
3rd Year
4th Year
5th Year Undergraduate
What is your choice for a major?
What kind of Financial Aid were you awarded for the current school year?
Federal Grants
State Grants
Work Study
Loans
Scholarships
None
Other
From the list, pick the best reason why you did not graduate.
Financial Reasons
Personal Reasons
Time Constraints
College wasn\'t for me
Work Information
Are you currently working?
Yes
No
Where are you working?
What kind of employment?
Full Time
Part Time
Seasonal
How long have you been working here?
More than 5 year
4-3 Years
2-1 Years
Less than a year
What is your position title?
Armed Forces Information
Are you currently serving in the Armed Forces?
Yes
No
What branch?
What is your Military Occupational Specialty?
What is your term of service?
Upward Bound Information
Briefly describe any information that tells us how you are doing. Any immediate questions or concerns you may have about school, your major, general college information, or anything that could help y
If you could go back in time, what do you know now that you wish you had known when you were in high school?
Do you have any accomplishments, awards, or successes in your academic and professional careers?
Have there been any major set backs in your plans for your education or career?
Please send this form back immediately!
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