Options for Youth Charter Schools: Exit Survey

Successful Student Recovery (since 1999)

Options for Youth is dedicated to student recovery by helping students catch up on credits and returning them to their traditional home school for graduation or by graduating students in our program.

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Options for Youth Charter Schools

Please tell us about yourself. Please make sure to capitalize the first letters of your first and last names.

01)	First Name*

02)	Middle Name or Initial

03)	Last Name*

04)	Street Address*

05)	City/Town*

06)	State*

07)	Zip/Postal*

08)	Email Address

09)	Phone Number (Include Area Code)*

10)

Which Charter do you currently attend?*

	Burbank
	Hermosa Beach
	San Bernardino
	San Gabriel
	San Juan
	Upland
	Victor Valley

11)

If you are in the Burbank Charter, which center do you currently attend?

	Burbank 1
	Burbank 2
	Northridge
	Sylmar 1
	Sylmar 2

12)

If you are in the Hermosa Beach Charter, which center do you currently attend?

Van Nuys

13)

If you are in the San Bernardino Charter, which center do you currently attend?

San Bernardino

14)

If you are in the San Gabriel Charter, which center do you currently attend?

	Chino
	Irwindale
	La Crescenta
	Ontario
	Pomona 1
	Pomona 2
	San Gabriel

15)

If you are in the San Juan Charter, which center do you currently attend?

	Arden
	Carmichael
	North Highlands
	Rancho Cordova

16)

If you are in the Upland Charter, which center do you currently attend?

	Chino
	Fontana 1
	Fontana 2
	Rancho 1
	Rancho 2
	Upland

17)

If you are in the Victor Valley Charter, which center do you currently attend?

	Hesperia 1
	Hesperia 2
	Victorville 1
	Victorville 2
	Victorville 3
	Victorville 4
	Victorville 5

18)

Do you plan to graduate from Options For Youth?

	Yes
	No

19)

How soon will you finish ALL requirements for graduation?

	Less than one month
	One to three months
	Three to six months
	More than six months

20)

I will NOT be receiving my high school diploma from Options For Youth. I plan to:

	Graduate from my District School
	Graduate from a continuation or alternative school
	Graduate from an adult school
	Take the GED
	Take the CHSPE
	Attend community college without a high school diploma

21)

How was your teacher most helpful? Check all that apply.*

	He/She kept encouraging me.
	He/She called when I was late or did not show up for my appointment.
	He/She gave me a strict plan to follow.
	He/She communicated regularly with my parent or guardian.
	Other:

22)

How was the program most helpful to you in achieving your goals? Check all that apply.*

	One-on-one relationship with my teacher
	Being able to work at my own pace
	Being able to work while attending school
	Provided small group instruction/workshops as needed
	Helped me focus on what was needed for graduation
	Other:

23)

Please share your suggestions for additional services you would like OFY to offer. Check all areas of interest.

	Study Skills Workshops
	Resume Workshops
	Financial Aid Workshops
	College Application
	Parenting Workshops
	Job Interests
	Job Preparedness Workshop
	Interview Skills
	Other:

24)

What do you believe you will be doing one year after graduation? Please select one.*

	I will be continuing my education (not working)
	I will be continuing my education and working full time.
	I will be continuing my education and working part time.
	I plan to work full time.

25)

Which industry sector most closely matches the career field you are interested in pursuing?*

	Agriculture and Natural Resourses
	Art, Media, and Entertainment
	Building Trades and Construction
	Education, Child Development and Family Services
	Energy and Utilities
	Engineering and Design
	Fashion and Interior Design
	Finance and Business
	Health Science and Medical Technology
	Hospitality, Tourism and Recreation
	Information Technology
	Manufacturing and Product Development
	Marketing, Sales and Service
	Public Services (Protective Services, Legal & Government)
	Transportaion (Aviation, Aerospace & Vehicle service/repair)

26)

What level of education will your career require?*

	2-year degree (AA or AS)
	4-year degree (BA or BS)
	Certificate from a program
	Masters or Doctoral Degree
	Unknown

27)

I intend to or have applied to the following school(s):*

	Vocational/Technical School
	I have visited a campus
	I am thinking about enrolling
	I have enrolled
	2-year Community College
	I have visited a campus
	I am thinking about enrolling
	I have enrolled
	4-year University
	I have visited a campus
	I am thinking about enrolling
	I have enrolled
	Military Services
	I have visited a campus
	I am thinking about enlisting
	I have enlisted
	Other:

28)

Do you currently have a job?*

	Yes
	No

29)

Is your current job in a career field that you are interested in pursuing?*

	Yes
	No
	Not Applicable

30)

May we contact you in the future?*

	Yes
	No

Please indicate 2 people whom we can contact in case we are unable to reach you.

31)	Contact 1 Name (Please print clearly)

32)	Contact 1 Phone Number (Include Area Code)

33)	Contact 1 E-Mail

34)	Contact 2 Name (Please print clearly)

35)	Contact 2 Phone Number (Include Area Code)

36)	Contact 2 E-Mail

PLEASE PRINT THIS PAGE (1) Right click (2) Select "Print" (3) Print Page 5 (4) Write (print) your name and date on the printed page AND (5) Give the page to your teacher as proof of completion.

If you would like a copy of this submission, please put your email address in the field below.

Please Note: Questions marked with an asterisk (*) are required.

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