A student survey utilized periodically will assess student perception of progress and re-evaluate student needs. This gives the teacher a unique opportunity to conference with each student on an individual basis and foster rapport, which is a crucial element in retention. This form can be especially useful with a long-term student.
SECTION 1: Background Information
Name: ![]()
Age: ![]()
Sex:
Male ![]()
Female ![]()
Race:
White ![]()
Black ![]()
Hispanic ![]()
American Indian ![]()
Asian ![]()
Employment:
Full-time ![]()
Part-time ![]()
Unemployed ![]()
Retired ![]()
Highest grade completed: 1 2 3 4 5 6 7 8 9 10 11 12
SECTION 2: Class Information
If no, when was the last month and year that you were enrolled in classes?