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  5. High School Dropout Questionnaire
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Exit Survey
 
 
What is your gender?
 
Male
 
Female
 
 
 
What is your age?
 
13-14 years old
 
15-16 years old
 
17-18 years old
 
19 years and over
 
 
 
What is the highest grade level you have completed?
 
7th grade
 
8th grade
 
9th grade
 
10th grade
 
11th grade
 
 
 
Please specify your race
 
American Indian or Alaska Native
 
Asian
 
Black or African American
 
Native Hawaiian or Other Pacific Islander
 
White
 
Other
 
 
 
Please specify your ethnicity
 
Hispanic or Latino
 
Not Hispanic or Latino
 
 
 
What was the most difficult part of high school for you?
 
School work
 
Hours
 
Teachers
 
The school itself
 
 
 
Did you participate in any extra curricular activities or after school programs, clubs, etc?
 
Yes
 
No
 
 
 
What was your current GPA when you dropped out?
 
3.5 or higher
 
3.0 - 3.5
 
2.5-3.0
 
2.0-2.5
 
Less than 2.0
 
Not sure
 
 
 
What is the marital status of your parents/guardians?
 
Married
 
Divorced
 
Single
 
Widowed
 
Separated
 
 
 
If you were employed during high school, how many hours a week did you work?
 
Less then 10 hours
 
10-20 hours
 
20-30 hours
 
30 or more hours
 
I was not employed during high school