Student Exit Survey

SECTION I

The information provided will be used by the Student Services to send you a survey after you complete your iTECH program.

Student Namerequired

First Name

Last Name

Student Number

Mailing Address

If you cannot be reached at the above, please furnish the following information of a friend or relative:

Relative/Friend Name

First Name

Last Name

Relative/Friend Phone Number

Relative/Friend Mailing Address

Program you are currently enrolled in or have completed.

Current Employer

Hourly/Salary

If other, please specifiy

If other, please specify

Program Evaluation (Your comments are very important to help improve curriculum, classroom conditions, supplies/equipment available, etc.)0 / 1500