Sample

Questions marked with an * are required

Exit Survey

Gender

Male

Female

Prefer not to say

Email Address

How satisfied are you with the following:

Please drag and rank(1^st to 3^rd) the following in order of interest:

	Drag your choices here to rank them
Ethics Staff Support Staff Training Community Training Parent Nights

Please rate the following:

School Administration

School Teachers

School Counselors

Other School Staff

The information provided in this survey will only be used by (School Name Here) for compiling data on successes and opportunities for use in program management.

I Agree

Please Provide the Fowling contact information. Your email is not required by highly suggested. Your email will only be used with (School Name Here) will not be sold to third party's.

* First Name :

* Last Name :

Address 1 :

Address 2 :

City :

State :

Zip :

Phone :

Email Address :