Name

	SSN or Student ID:

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

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	Cosmetology	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
		Enhance my job skills in my present field of work but not to graduate from Coastal
		Enhance my job skills for a new line of work but not to graduate from Coastal
		To take courses to transfer to another college but not to graduate from Coastal
		Take courses for personal interest only

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		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	Medical Problems	Schedule conflicts
		New Employment	Moved to new area	Transferred to another College
		Financial hardship	Lack of interest in pursuing course of study	Academic
		Family circumstances	Dissatisfied with quality of instruction	Personal
		Military	Dissatisfied with Instructor	Courses that I need are not currently being offered
		Childcare Problems	Dissatisfied with Services

Q4	What is your current status?
	Employed	Go to Q5	Enrolled at another Community College/University		Neither

Q5

If employed, what is your job title?

Q6	Is your job related to your studies at Coastal?		Yes
			No

Q7	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 Resource Center	Learning Resource Center Excellent		Learning Resource Center Above Average		Learning Resource Center Average		Learning Resource Center Below Average		Learning Resource 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	College Foundation Excellent		College Foundation Above Average		College Foundation Average		College Foundation Below Average		College Foundation 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

Q8	Please indicate your response to the following questions.
		Yes		No		Not Sure
	Do you plan to re-enroll at this community college during the next year?	Do you plan to re-enroll at this community college during the next year? Yes		Do you plan to re-enroll at this community college during the next year? No		Do you plan to re-enroll at this community college during the next year? Not Sure
	If you were to begin again, would you choose to attend this community college?	If you were to begin again, would you choose to attend this community college? Yes		If you were to begin again, would you choose to attend this community college? No		If you were to begin again, would you choose to attend this community college? Not Sure

Q9	Could we have done anything differently that may have helped you remain in college?                                                                                Could we have provided you . . . (select all that apply)
		help in getting a job?	tutoring?	help with writing?
		help in obtaining financial aid?	personal counseling?	help with math?
		help with childcare?	help with reading?	help with study skills?

Q10	Please add any comments or suggestions in the box below: