Work+Base+Learning+Follow+up

  Work-Based Learning //STUDENT FOLLOW-UP FORM  //   ** Name  ** :___________________________________ ** Phone **:__________ ** Graduation Date: **_______  // (Last) (First) (Middle)  //  ** Current Address  ** :__________________________________________________________________________  // (Street) (City) (State) (Zip Code) //  ** Post High School Endeavors:  ** (Check One)   Not Certain  Additional Education _____________ Area of Study _____________   Military ____________  Immediate Employment _____________________  // Branch Employer // //  Please provide the name of a relative or friend that will most likely be at the following address three years from now:   // ** Name  ** : _______________________________________ ** Phone **:______________ ** Relation: ** // (Last) (First) (Middle)  // ** Address  ** : //  (Street) (City) (State) (Zip Code)   // = ONE YEAR AFTER GRADUATION = What is your current name and address? ** Name  ** :______________________________________ ** Phone **:______________ ** Marital Status **: // (Last) (First) (Middle)  // ** Address  ** : //  (Street) (City) (State) (Zip Code)   // Are you employed? ___ Yes ___ No If yes, please provide the following information: Employer:________________________________________________________________ Employer’s Address:______________________________________________________ Job Title:_________________________________________________________________ Length of Time At Job:____________________________________________________ ___ Part-time ___ Full-time Approximate Gross Salary: $______________ If you are not employed, are you seeking work? ___ Yes ___ No     Which of the following assisted you most in securing your present job? ___ Academic Teacher ___ Counselor ___ Parent ___ Relative ___ Teacher-Coordinator ___ Want Ad ___ Friend ___ Other Internet Rate the academic and Career and Technical counseling you received: ___ Good ___ Average ___ Poor ___ None Please list any additional comments/recommendations you feel may be useful in planning a better Work-Based Learning program: