Walters State Community College
Completer/Leaver Follow-Up Form

NOTE: This report is required by the Tennessee Board of Regents for the State University and Community College System of Tennessee.  While you are not required to respond to this survey, your cooperation is needed to insure that the results of this effort are comprehensive, reliable, and timely.

Name ________________________________________________

Semester & Year of Graduation ____________________________

1. What is your current educational status? (Mark one)
Currently attending school      Name of School __________________________
Date Enrolled _____________________________________________________
Major ___________________________________________________________
Not Currently Attending School
2. What is your current employment status? (Mark one)
Employed ( Includes all employment, even if below your qualifications; does not include full-time military service.)
Employed (Full-time military service.)
Unemployed (Not employed, but actively seeking employment.)
Not in the labor force (Not employed and not seeking employment because (Mark One)
Illness Choice Full-time Student Status Retired Pregnancy or Other____________________

NOTE: If you are currently employed, please answer the remaining questions. Otherwise, skip to item 7.

3. Please provide the following information on your present job:

    (if self-employed, please write self; if volunteer work is related, please provide)

NAME OF COMPANY OR  FIRM ___________________________________________
Company or Firm Mailing Address ___________________________________________
City________________________________________
State ____________  Zip Code __________________
Phone ______________________________________
Your Immediate Supervisor______________________
PRESENT JOB INFORMATION:
Date of Employment ____________________________________________
Job Title ____________________________________________
Job Duties ____________________________________________
4. Is this job related to your field of educational training?
Yes, directly or closely related.
No, only remotely related or not related at all.
5. What is your current salary before deduction?
Do not add in overtime: $_____  Per: _______
Employment is: Full-time Part-time
6.The salary in the preceding item is based on how many hours per week employment?
_____________________________________________________
7. If you are not presently employed in a job related to your field of educational training, please indicate the reason why.
at the request of my present employer or as requirement to keep my present job
no jobs available in related field
jobs available, but could not qualify
changed career goals after completing training
related jobs available in East Tennessee, but have moved into another part of the country where no related jobs are available
volunteer work _________________________________
other
8. If you have moved or changed your mailing address since you graduated from WSCC, please fill in the blanks below:
Address _____________________________________
City _____________________________________
State __________  Zip Code __________________
Phone _____________________________________

An Affirmative Active / Equal Opportunity Employer. We comply with Title IX of the Education Amendments of 1972, the Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990.

Thank you very much for your cooperation.