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Focus Beyond Exit Questionnaire 2017-18
Please fill out the following information about students who have exited / will exit this school year
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* Indicates required question
Name
*
Your answer
Date of birth
*
Your answer
Gender
Female
Male
Non-binary
Address
*
Your answer
Ethnicity
*
African American
African
Asian
American Indian or Alaskan Native
Latino
White
Middle Eastern
Bi Racial
Multi Racial
Other
Required
If you answered other please specify.
Your answer
English
*
Please list student's primary language.
Your answer
Home Language
*
Your answer
What is student's status upon leaving Focus Beyond?
*
Graduate
Drop
Age out/No diploma
Enrolled in other district/school
Required
Has this student dropped and re-enrolled during their period of eligibility?
*
Yes
No
Required
Is the student his/her own guardian?
*
Yes
No
Required
Is student homeless?
*
Yes
No
Required
Is student enrolled/registered in...?
*
Please check check the boxes if the student is enrolled/registered for programs currently or starting in the next 3 months.
Competitive employment
Supported employment (Job Coached)
Temporary summer employment (Right Track)
DTH (Day Training and Habilitation)
Training program (Goodwill, Red Cross, MRC)
2 or 4 year college or technical college
Adult Basic Education (Hubbs, Community Education)
Military
Other employment (self employed, family business)
None of the above
Required
What community support is student receiving?
*
Vocational Rehab
County DD
Personal Care Attendant
Public Health Nurse
AMHRS Worker
County Mental Health
None of the above
Required
Is student connected to any self advocacy or recreation groups?
*
(i.e. ARC, MCIL, Autism Society, Fraser, adaptive recreation, Friendship Club)
Yes
No
Required
Case Manager
*
Your answer
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