Graduate Contact Form

Graduate Contact Information

Graduate's Name While in School

First Last

Program

Major(s)

Campus attended

Brainerd
Staples

Please indicate who is responding to this survey:

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

Continuing Education

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

Yes
No (If no, continue to 'Employment Information' section below)

Please write the complete name of the institution and its location

What degree have you obtained or are you pursuing?

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

What was the date you started or were accepted to this program? Month/Day/Year

Employment Information

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

Yes
No - If No, continue on to the 'Not Currently Employed' section

If you answered yes, and are continuing your education, please indicate in which group you prefer to be included

Employment
Continuing Education

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

Employer Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Job Title/Position

Job Duties

Is the position on average considered to be

Full-time
Part-time

Beginning date of job: Month/Day/Year

Salary per hour

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: 1) You were required to complete your program or major in order to qualify for this job; 2) Your are/were using knowledge and skills on your job acquired through your program or major; or 3) Your job is/was an entry-level position required in order to obtain a job for which you were trained.

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 -

Not Currently Employed

Answer this section only if you are not currently employed

Which of the following describes your status?

Not currently employed, actively seeking employment
Not currently employed, not actively seeking employment due to:

Reason for not 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 Last

Date

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

Thank you!

Contact Information - Amy Matter-Hines, CLC Foundation & Alumni Assistant, amy.matter-hines@clcmn.edu Phone: 218-855-8135 Toll free: 1-800-855-8135

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.