STUDENT FOLLOW-UP FORM
(Revised August 2009)

Note: This report is authorized by law (20 USC 2312 and 20 USC 2391). While you are not required to respond to this survey, your cooperation is needed to insure that the results of this effort are comprehensive, reliable, and timely. Your cooperation in this matter would be very much appreciated.
Name:
Social Security Number:
Address:
City:
State:
Zip Code:
Phone Number:
Program you were
enrolled in:

1.  What is your current education status? (Choose only one)
Currently attending school
Not currently attending school
2.  What is your current employment status?
3.  Were you unavailable for unemployment? (Pregnancy, serious illness, etc.) {#15 on report}
No
Yes
4.  Did you refuse employment? (Failed to keep interview appointments, took program for personal use, or refused employment)
Yes
No
5.  NOTE: If you are currently employed or in full-time military service, please answer the remaining questions.
Name of Company:
Address:
City:
State:
Zip Code:
Company Phone Number:
Name of your immediate supervisor:
Job Title:
Job Duties:
6.  Is this job related to your field of vocational training?
Yes, it is directly or closely related.
No, it is only remotely related or is not related at all.
7.  What is your current salary? Do not include overtime.
$
Per
Hours worked per week:
Employment start date: