DR. FRANCES HAITHCOCK
CHANCELLOR OF PUBLIC SCHOOLS
325 W. GAINES STREET • SUITE 514 • TALLAHASSEE, FL 32399-0400 • (850) 245-0509 • www.fldoe.org
S
TATE BOARD OF EDUCATION
T. WILLARD FAIR,
Chairman
Members
PETER BOULWARE
DR. AKSHAY DESAI
ROBERTO MARTÍNEZ
JOHN R. PADGET
KATHLEEN SHANAHAN
LINDA K. TAYLOR
MEMORANDUM
TO:
District Superintendents
District Dropout Prevention Directors
School Guidance Counselors
FROM:
Dr. Frances Haithcock
DATE:
August 7, 2009
SUBJECT: EXIT INTERVIEW STUDENT SURVEY
This memorandum provides an update to the technical assistance documents released in 2006 related to
the Exit Interview Student Survey. Section 1003.21, Florida Statutes, requires that an exit interview be
conducted by a student’s guidance counselor or other school personnel when a student has filed a formal
declaration of intent to terminate school enrollment. In addition, students must complete a survey in a
format prescribed by the Department of Education that provides data on students’ reasons for terminating
enrollment and actions taken by schools to keep students enrolled.
Beginning with school year 2009-2010, the fourth question on the Exit Interview Student Survey will
require a closed-ended response. The question will now be formatted with 15 multiple response items
identifying possible actions taken by school personnel to keep students enrolled in school.
If you have questions, please contact Dr. Kimberly Davis, Director of Dropout Prevention, by phone at
(850) 245-0551 or via e-mail at
Kimberly.Davis@fldoe.org. You may also contact Joseph Davis, Bureau
Chief, Family and Community Outreach, by phone at (850) 245-0847 or via e-mail at
Joseph.Davis@fldoe.org.
FH/kd
FLORIDA DEPARTMENT OF EDUCATION
Dr. Eric J. Smith
Commissioner of Education
Contact Information:
Kimberly Davis
(850) 245-0551
Kimberly.Davis@fldoe.org
DPS: 2009-136
1
Florida Department of Education
Exit Interview Student Survey
School Name ______________________________________________ School District _________________
Student Name ______________________________________________ Student DOB ________________
Grade Level ______________________________________________ Date ________________________
Directions: Please circle the response that best describes your experience or provide a description of your
experience in the space provided.
1. Which of the following best describes your
primary
reason for terminating school enrollment?
A. Classes were not interesting/bored K. Student-teacher conflict
B. Missed too many days and could not catch up L. Employment/have to work full-time
C. Did not like school M. Friends dropped out
D. Failing classes/couldn’t keep up with school work N. Failed to pass FCAT
E. Illness O. Intimidated/Threatened/Bullied
F. Became a parent P. Migrant
G. Getting married Q. Homeless
H. Felt like I did not belong R. Family Problems
I. Suspended from school often S. Other
J. Expelled from school
2. Which of the following best describes your
secondary
reason for terminating school enrollment?
A. Classes were not interesting/bored K. Student-teacher conflict
B. Missed too many days and could not catch up L. Employment/have to work full-time
C. Did not like school M. Friends dropped out
D. Failing classes/couldn’t keep up with school work N. Failed to pass FCAT
E. Illness O. Intimidated/Threatened/Bullied
F. Became a parent P. Migrant
G. Getting married Q. Homeless
H. Felt like I did not belong R. Family Problems
I. Suspended from school often S. Other
J. Expelled from school
3. What would have improved your chances of staying in school? (Circle all that apply.)
A. Opportunities for real-world learning (internships, service learning)
B. Better teachers
C. Smaller classes
D. More individualized instruction
E. Better communication with your teachers
F. Better communication with your parents
G. Increased parental involvement
H. Less freedom and more supervision from parents
I. Less freedom and more supervision from school officials
J. Other
2
4. What actions did your school personnel take to keep you enrolled in school? (Circle all that apply.)
A.
Provided student counseling I. Discussed and offered participation in a
B.
Scheduled a conference with parent(s), guardian(s), credit recovery course/program
student, and school staff J. Discussed and offered access to Dropout
C.
Discussed and offered options for tutoring Prevention Program(s) (e.g., alternative
D.
Discussed the consequences of dropping out education, disciplinary, teenage parent)
E.
Discussed and offered options for continuing K. Tracked student progress (by teacher,
education in a different environment (e.g., Adult counselor, social worker, graduation coach,
Education, home school, virtual school, hospital etc.)
homebound) L. Changed or revised course schedule
F. Discussed and offered alternative options for M. Implemented intervention contracts (e.g.
graduation (e.g., diploma options or GED Testing) attendance or behavior)
G. Conducted home visits N. Student reported that school staff took no
H. Referred student to agencies/programs to address action
problems interfering with school success (e.g., O. Other
substance abuse counseling, psychological counsel- Z. Not Applicable. Student did not drop out
ing, family counselor) of school or did not provide information
about actions taken
Please check and sign below to certify that each of the following statements was addressed by school
personnel.
I am at least 16 years of age and it is my intent to terminate my school enrollment. I received counseling from a
guidance counselor or other school personnel which addressed the following:
Terminating school enrollment prior to graduation will likely reduce my potential earnings and negatively
affect my career options.
Termination of school enrollment will result in the revocation/denial of my driving privileges until age 18.
My reasons for leaving school prior to graduation.
Possible actions that could keep me from leaving school prior to graduation.
Options for continuing my education in a different environment, e.g., Adult Education or GED testing.
For Bright Futures eligibility, GED students must complete credit requirements before taking GED exam.
Student Signature: ____________________________________________ Date: ________________________
Parent/Guardian Signature: _____________________________________ Date: ________________________
(if student is under 18 years of age)
School Personnel Signature: ____________________________________ Date: ________________________
Optional:
1. What is the highest level of education completed by your maternal parent/guardian? (circle one)
Elementary Middle School High School College Graduate School Unknown
2. What is the highest level of education completed by your paternal parent/guardian? (circle one)
Elementary Middle School High School College Graduate School Unknown
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