Graduate Contact Information Form

Part A: Graduate Contact Information

Graduate's Name (While in School):
Program:
Major(s):
Campus attended:	Brainerd Staples
Social Security #
Date of Graduation (month/day/year) :

Please indicate who is responding to this survey:

Graduate	Spouse/Domestic Partner	Parent/Guardian
Institutional Staff	Employer	Other Family Member

Part B: Continuing Education

1. Since graduation, have you obtained or are you pursuing (accepted or enrolled at an institution) another degree, diploma, or certificate?

Yes - If Yes, Continue with this Part

No - If No, Go to Part C, Item 4

Please write the complete name of the institution and its location

Institution

City/State

2. What degree have you obtained or are you pursuing?

Certificate	Diploma	Associate	Bachelor's
Master's	Specialist	Doctorate	First Professional (e.g. Dentistry, Law, Medicine)

3. What was the date you started or were accepted to this program?

Month/Day/Year

Part C: Employment Information

4. Have you started, accepted, or continued a paying job following graduation? (Include self-employment, Peace Corps, military service, or religious mission.

Yes - If Yes, Continue with items 5 through 10

No - If No, Go to Part D, Item 11

5. If you answered yes to Item 4 and you reported continuing education in Part B, please indicate in which group you prefer to be included

Employment Continuing Education

6. Please provide the following information about your job. If you have held or accepted more than one job, please provide information on what you consider to be the most important.

Employer / Firm Name:
Address:
City, State, Zip:
Telephone:
Job Title / Position:
Job Duties:

7. Is the position on average considered to be:

Full-Time Part-time

8. Beginning date of job:

Month/Day/Year Salary: per

9. How related is/was this job to the program from which you graduated?

Related Somewhat Related Unrelated

Note: Your job is at least somewhat related if it meets at least one of the following criteria:

You were required to complete your program or major in order to qualify for this job;
Your are/were using knowledge and skills on your job acquired through your program or major;or
Your job is/was an entry-level position required in order to obtain a job for which you were trained.

If you checked "Unrelated", continue with Item 10. Otherwise, you have finished the survey. Thank you

10. Are you actively seeking a job related to your program or major?

Yes

No - Reasons why you might not be seeking a related job include the following;

Occupational License or Certification Pending
Medical Condition Preventing Work in Field of Study
Completed Program for Personal Satisfaction
Cannot Relocate for Related Employment
Family/Home Responsibilities
Continuing Education
Military/Volunteer/Religious Service
Took Unrelated Work by Choice

Part D: Not Currently Employed

Answer Item 11 only if you checked "No" in response to Item 4 above.

11. Which of the following describes your status?

Not currently employed, actively seeking employment

Not currently employed, not actively seeking employment due to:

Occupational License or Certification Pending
Medical Condition Preventing Work
Completed Program for Personal Satisfaction
Cannot Relocate for Related Employment
Family/Home Responsibilities
Continuing Education
Incarcerated
International Student Returned to Homeland

You have finished the survey, please enter your name and date below.

Name (First and Last)
Today's Date

Comments: Please provide any additional comments you may have regarding your education, instructor, services, etc.

Would you like to remain on our mailing list for job opening notices in your field?
Yes No

Thank you!

Charlotte Daniels
Central Lakes College - Staples Campus
1830 Airport Road - Staples MN 56479

If you are currently enrolled at an institution within the Minnesota State Colleges and Universities System, please read NOTE A. If you are not currently enrolled at an institution within the Minnesota State Colleges and Universities System, please read NOTE B.

NOTE A. The College is asking you to provide information that includes private information under state law. The college is making this request in order to provide summary information about your program of study to students and prospective students. You are not legally required to provide the information the college is requesting. With some exception, unless you consent to further release of private information, access to this information will be limited to school officials, including faculty who have legitimate educational interests in the information. Under certain circumstances federal and state laws authorize release of private information without your consent: to federal, state or local officials for purposes of program compliance, audit or evaluation; if the information is sought with a subpoena, court order, or otherwise permitted by other state or federal law; and to an institution engaged in educational research or accrediting agency.

NOTE B. The college is asking for this information in order to provide summary information about your program of study to students and prospective students. Under Minnesota and federal law the requested information is public information. You are not legally required to provide the information the college is requesting.

It is the policy of Central Lakes College to comply with federal and state law prohibiting discrimination in student admissions or treatment of students or employees on the basis of race, color, creed, sex, age, national origin, marital status, sexual preference, handicap, disability, status with regard to public assistance, or other protected groups. Upon request, this information will be made available in an alternative form.