Name

	SSN or Student ID:

	Today's Date: (MM/DD/YYYY)

	Mailing Address:
	Personal Email Address:
	Cell Phone Number:

Curriculum	(Please select the program in which you were enrolled)
	College Transfer (AA, AE, AFA, AGE, AS)	Computer Programming & Development	Electronics Engineering                                                              Technology	Medical Office Administration
	Accounting & Financial Services	Cosemetology	Emergency Management	Network Management
	Air Cond./Heat/Refrigeration	Criminal Justice Technology	Emergency Medical Science	Office Administration
	Architectural Technology	Culinary Arts	Fire Protection Technology	Paralegal Technology
	Associate Degree Nursing	Dental Assisting	Health/Fitness Science	Practical Nursing
	Automotive Systems Technology	Dental Hygiene	Hospitality Management	Surgical Technology
	Basic Law Enforcement Training	Diesel/Heavy Equipment    Technology	Information Systems	Web Administration & Design
	Business Administration/ Entrepreneurship	Early Childhood Education	Manicuring/Nail Technology	Welding Technology
	Collision Repair/Refinishing Technology	Electrical Systems Technology	Medical Laboratory                                                                     Technology

Q1	What was your primary goal for attending Coastal? (Please select only one)
		Graduate with an Associate Degree, Diploma, or Certificate	To take courses to transfer to another college but not to graduate from Coastal
		Enhance my job skills in my present field of work but not to graduate from Coastal	Take courses for personal interest only
		Enhance my job skills for a new line of work but not to graduate from Coastal

Q2	To what extent do you feel you accomplished your goal while attending Coastal? (Please select only one)
	Fully accomplished	Skip to Q4	Partially accomplished	Go to Q3	Not accomplished

Q3	If you did not accomplish your goal while attending Coastal, which of the following describes why you did not acheive that goal and your reason for leaving.
	Job conflict	Family circumstances	Medical Problems	Dissatisfied with the quality of instruction
	New Employment	Military	Moved to new area	Dissatisfied with the services offered by CCCC
	Financial hardship	Childcare Problems	Lack of interest in pursuing course of study	Other

Q4	What is your current employment status?
	Retired		Unemployed-seeking employment		Employed full-time
	Unemployed-not seeking employment		Employed part-time

Q5	Is your job related to your studies at Coastal?
	Yes		No

Q6	May we contact your current or future employer?
	Yes	Please make sure you complete Q7	No

Q7

If employed: Job Title: Company Name: Supervisor's Name/Number: Company Address:

Q8	After graduation, will you re-enroll in another curriculum at this college?		Yes
			No

Q9	Will you transfer to another two or four year college?		Yes
			No

If yes, what college?                                                       Where is it located?

Q10	Did you receive accurate information about the transferability of transfer courses?	Yes		NA
		No

Q11	If you do not plan to re-enroll in another curriculum at this college or transfer to another college, will you enroll in Continuing Education classes at this college after graduation?
	Yes		No		Not sure

Q12	Would you consider taking any courses at this college in the future?
	Yes		No		Not sure

Q13	If you were to begin again, would you choose to attend this college?
	Yes		No		Not sure

Q14	Please indicate your rating of the following services by filling in the most appropriate response.
		Excellent		Above Average		Average		Below Average		Poor
	Quality of Instruction in Program Area Courses	Quality of Instruction in Program Area Courses Excellent		Quality of Instruction in Program Area Courses Above Average		Quality of Instruction in Program Area Courses Average		Quality of Instruction in Program Area Courses Below Average		Quality of Instruction in Program Area Courses Poor
	Quality of Instruction in Other Courses	Quality of Instruction in Other Courses Excellent		Quality of Instruction in Other Courses Above Average		Quality of Instruction in Other Courses Average		Quality of Instruction in Other Courses Below Average		Quality of Instruction in Other Courses Poor
	Overall Quality of Academic Program	Overall Quality of Academic Program Excellent		Overall Quality of Academic Program Above Average		Overall Quality of Academic Program Average		Overall Quality of Academic Program Below Average		Overall Quality of Academic Program Poor
	Teaching Facilities	Teaching Facilities Excellent		Teaching Facilities Above Average		Teaching Facilities Average		Teaching Facilities Below Average		Teaching Facilities Poor
	Equipment	Equipment Excellent		Equipment Above Average		Equipment Average		Equipment Below Average		Equipment Poor
	Learning Resources Center	Learning Resources Center Excellent		Learning Resources Center Above Average		Learning Resources Center Average		Learning Resources Center Below Average		Learning Resources Center Poor
	Admissions Procedures	Admissions Procedures Excellent		Admissions Procedures Above Average		Admissions Procedures Average		Admissions Procedures Below Average		Admissions Procedures Poor
	Academic Advising	Academic Advising Excellent		Academic Advising Above Average		Academic Advising Average		Academic Advising Below Average		Academic Advising Poor
	ADA Accommodations	ADA Accommodations Excellent		ADA Accommodations Above Average		ADA Accommodations Average		ADA Accommodations Below Average		ADA Accommodations Poor
	Financial Aid	Financial Aid Excellent		Financial Aid Above Average		Financial Aid Average		Financial Aid Below Average		Financial Aid Poor
	Veterans Affairs	Veterans Affairs Excellent		Veterans Affairs Above Average		Veterans Affairs Average		Veterans Affairs Below Average		Veterans Affairs Poor
	Registration Procedures	Registration Procedures Excellent		Registration Procedures Above Average		Registration Procedures Average		Registration Procedures Below Average		Registration Procedures Poor
	Student Activities	Student Activities Excellent		Student Activities Above Average		Student Activities Average		Student Activities Below Average		Student Activities Poor
	Business Office	Business Office Excellent		Business Office Above Average		Business Office Average		Business Office Below Average		Business Office Poor
	Bookstore	Bookstore Excellent		Bookstore Above Average		Bookstore Average		Bookstore Below Average		Bookstore Poor
	Cafeteria	Cafeteria Excellent		Cafeteria Above Average		Cafeteria Average		Cafeteria Below Average		Cafeteria Poor
	Security	Security Excellent		Security Above Average		Security Average		Security Below Average		Security Poor
	Computer Resources on Campus	Computer Resources on Campus Excellent		Computer Resources on Campus Above Average		Computer Resources on Campus Average		Computer Resources on Campus Below Average		Computer Resources on Campus Poor
	College Foundation Office	College Foundation Office Excellent		College Foundation Office Above Average		College Foundation Office Average		College Foundation Office Below Average		College Foundation Office Poor
	Overall Quality of the College	Overall Quality of the College Excellent		Overall Quality of the College Above Average		Overall Quality of the College Average		Overall Quality of the College Below Average		Overall Quality of the College Poor
	Overall Coastal Experience	Overall Coastal Experience Excellent		Overall Coastal Experience Above Average		Overall Coastal Experience Average		Overall Coastal Experience Below Average		Overall Coastal Experience Poor