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    Drop - Out Survey Form

    Uploaded by

    Irene Dulay
    This document is a student dropout questionnaire for Tropical Village National High School that collects information about a withdrawing student's demographics, primary reason for leaving school, academic performance, disciplinary record, eligibility for programs, and parents' education levels. It asks the student's name, withdrawal date, grade, age, gender, main reason for leaving such as failing grades or family problems, alternative education history, counseling received, extracurricular involvement, disability status, remediation services, suspension/expulsion details, and absenteeism over the past 3 years. A parent and guidance teacher must sign and date the completed form.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    Drop - Out Survey Form

    Uploaded by

    Irene Dulay
    128 views1 page
    This document is a student dropout questionnaire for Tropical Village National High School that collects information about a withdrawing student's demographics, primary reason for leaving school, academic performance, disciplinary record, eligibility for programs, and parents' education levels. It asks the student's name, withdrawal date, grade, age, gender, main reason for leaving such as failing grades or family problems, alternative education history, counseling received, extracurricular involvement, disability status, remediation services, suspension/expulsion details, and absenteeism over the past 3 years. A parent and guidance teacher must sign and date the completed form.

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    school form

    Original Title

    Drop -out survey Form

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    This document is a student dropout questionnaire for Tropical Village National High School that collects information about a withdrawing student's demographics, primary reason for leaving school, academic performance, disciplinary record, eligibility for programs, and parents' education levels. It asks the student's name, withdrawal date, grade, age, gender, main reason for leaving such as failing grades or family problems, alternative education history, counseling received, extracurricular involvement, disability status, remediation services, suspension/expulsion details, and absenteeism over the past 3 years. A parent and guidance teacher must sign and date the completed form.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    128 views1 page

    Drop - Out Survey Form

    Uploaded by

    Irene Dulay
    This document is a student dropout questionnaire for Tropical Village National High School that collects information about a withdrawing student's demographics, primary reason for leaving school, academic performance, disciplinary record, eligibility for programs, and parents' education levels. It asks the student's name, withdrawal date, grade, age, gender, main reason for leaving such as failing grades or family problems, alternative education history, counseling received, extracurricular involvement, disability status, remediation services, suspension/expulsion details, and absenteeism over the past 3 years. A parent and guidance teacher must sign and date the completed form.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
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    Tropical Village National High School

    Student Dropout Questionnaire

    Student Name: ______________________________________ Withdrawal Date: _______________________


    Grade Level: ________________ Age: __________ Gender: ________

    What is the primary reason the student is withdrawing from school? ( Check one)
    _____ Student/Teacher Conflict _____ Failing Grades _____ Boredom
    _____ Employment _____ Illness _____ Pregnancy
    _____ Marriage _____ Expulsion _____ Family Problems
    _____ Transfer of Residence

    Was the student in an alternative setting prior to withdrawal from school? Yes No
    If the answer is no, was an alternative setting available? Yes No
    Had the student received individual counseling prior to this meeting? Yes No
    Was the student involved in school-sponsored extracurricular activities? Yes No

    Does the student have an educational disability? Yes No


    Has the student received any remediation services in the past three (3) years? Yes No
    Has the student ever been suspended? Yes No
    If yes, how many times? _____
    Has the student ever been expelled? Yes No
    If yes, how many times? _____
    What is the average number of days the student was absent over the past
    three (3) years? _____

    Is the student eligible for the feeding program? Yes No


    Optional: What is the highest level of education completed by either
    parent/guardian?( check one)
    ___ Elementary _____ High School _____ College

    ________________________________ __________________________________________
    Parent’s Signature Above Printed Name Guidance Teacher’s Signature Above Printed Name

    Date: ___________ Date: __________

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