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Dropout Supplement Form

This form is to be completed by students who dropped out of school to provide their name, address, gender, age, religion, and reason for dropping out by checking all applicable options such as academic difficulty, marriage, pregnancy, disliking school, or needing to work. Space is also provided for additional comments from the student, parent/guardian, and adviser.

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39 views

Dropout Supplement Form

This form is to be completed by students who dropped out of school to provide their name, address, gender, age, religion, and reason for dropping out by checking all applicable options such as academic difficulty, marriage, pregnancy, disliking school, or needing to work. Space is also provided for additional comments from the student, parent/guardian, and adviser.

Uploaded by

C h i l l Laags
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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DROPOUT SUPPLEMENT FORM

This form is to be completed and attached to the Exit Survey (student/parent) or the One Year
Follow Up Survey ONLY if the student dropped out of school during the school year for which
the survey is completed.

_____________________________________________________________________________________
First Name MI Last Name

Address: ____________________________________________________________________

Gender:  Female  Male


Age: ___________
Religion: ________

Please mark the reason for dropping out of school (check all that apply)

 Academic difficulty  Marriage


 Behavior difficulty  Pregnancy
 Dislike of the school experience
 Economic Reasons  Needed at home
 Employment  Parental Influence
 Exceeded allowable absences  Physical illness or disability
 Family care responsibilities  Poor student/staff relationship
 Lack of appropriate curriculum  Poor relationship with fellow students
 Lack of interest or motivation  Transportation difficulties
 Expelled (with no option to return for the remainder of the school or 12 months)

 Other: __________________________________________________________

Additional comments:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

________________ _______________
Student Parent/Guardian

_______________
Adviser

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