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Exit Questionnaire
First Name
*
Classes Taken
*
Last Name
*
Age
*
Email
*
Phone
*
City
*
Zip
*
What country are you from?
*
Race
*
Race
A
American Indian or Alaska Native
B
Asian
C
Black or African American
D
Native Hawaiian or other Pacific Islander
E
White
F
Prefer not to disclose
Ethnicity
*
Ethnicity
A
Hispanic or Latino
B
Not Hispanic or Latino
C
Prefer not to disclose
What language(s) do you speak at home?
*
Are you a military veteran?
*
Are you a military veteran?
A
Yes
B
No
Is your annual household income:
*
Is your annual household income:
A
Below $33,000
B
Above $33,000
Do you receive public assistance?
*
Do you receive public assistance?
A
Yes
B
No
Are you currently employed?
*
Are you currently employed?
A
Yes, full time
B
Yes, part time
C
No
Highest level of education completed
*
Highest level of education completed
A
Did not complete high school
B
High School Diploma / GED / Equivalent
C
Attended Trade School / Apprenticeship
D
Completed Trade School / Apprenticeship
E
Attended College, no degree
F
Associates (2 year) Degree
G
Bachelor's (4 year) Degree
H
Graduate or professional degree (Post-Bachelor Degree)
How much did this class improve your...
*
None
A little
Some
Good
Great
Understanding of
Spoken
English
Speaking
in English
Reading
English
Writing
in English
Social
confidence
with native English speakers
What was most helpful in this class?
*
How did the class improve your work, family, and social life?
*
How can we make this class better?
*
Submit
