While in high school you took a [CEP Name] course for ...



1. I graduated from

High School

City/State

If different, I took [CEP Name] course(s) at the following location:

High School or Career Center

City/State

2. The number of [Postsecondary Institution Name] college credits I earned by taking [CEP Name] courses is .

3. I would rate my overall experience with [CEP Name]:

o Excellent

o Good

o Neutral

o Poor

o Very Poor

|I took [CEP Name] courses in the following discipline(s): (Check all that apply) |

|Humanities & Social Sciences |Mathematics & Sciences |Career and Technical |

|Communication |Biology |Agriculture, Food, and Natural Resources |

|College Success Skills |Chemistry |Architecture |

|Economics |Environmental Science |Automotive |

|English & Composition |Mathematics |Business |

|Foreign Languages |Physics |Computer Science/Information Technology |

|Government |Other |Construction Trades |

|History | |Engineering/Engineering Technology |

|Psychology | |Journalism/Communications Technology |

|Visual & Performing Arts | |Manufacturing/Industrial Technology |

|Other | |Medical/Health Sciences |

| | |Teacher Education |

| | |Other |

|Please describe what you are currently doing (select only one option) | |

| |The highest degree or certificate I |

| |eventually plan to obtain is a: |

| |I am not currently continuing my education. I am | |

|I am continuing my education in a: | | |

|Career School or College, or an Apprenticeship |Serving in the Military or other National Service |High School Diploma or Equivalent |

|Program | | |

|Public 2-Year Community or Technical College |Employed Part-time, Full-time, or Self-Employed |Technical Certificate or Diploma |

|Private 2-Year Community or Technical College |Caring for a Home/Family |Associate's Degree |

|Public 4-Year College or University |Unemployed |Bachelor's Degree |

|Private 4-Year College or University |Other |Graduate Degree |

Yes No

7. I would recommend [CEP Name] courses to current high school students o o

|By taking the [CEP Name] course(s), I: |Strongly | | | |Strongly |

| |Agree |Agree |Neutral |Disagree |Disagree |

|Was better prepared academically for college |o |o |o |o |o |

|Developed more realistic expectations about college |o |o |o |o |o |

|Was more confident about my ability to succeed in college |o |o |o |o |o |

|Considered, for the first time, enrolling in college |o |o |o |o |o |

|Improved my study skills |o |o |o |o |o |

|Improved my time management skills |o |o |o |o |o |

If you are not currently continuing your education, please skip to question 14.

9. I am currently enrolled in postsecondary coursework at:

Name: City/State:

| |Yes |No |

|I qualified for a Pell Grant for college |o |o |

|The [CEP Name] course(s) was/were at least as challenging as the courses I enrolled in at my current |o |o |

|college or university | | |

|I attempted to transfer some or all of the [Postsecondary Institution Name] credits I earned through |o |o |

|[CEP Name] to my current college or university | | |

|I was able to successfully transfer some or all of the [Postsecondary Institution Name] credits I |o |o |

|earned through [CEP Name] to my current college or university | | |

If yes, the credits: (Check all that apply)

o Enabled me to enroll in a more advanced course

o Exempted me from a required course

o Counted as credit toward my college degree completion

o Other:

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The next few questions may seem personal. We ask these questions because governmental and education-related agencies often want to know who is served by [CEP Name].

10. I am:

o Female

o Male

11. Do you consider yourself Hispanic or Latino?

o Yes

o No

12. Which category best describes your race? (Check all that apply)

o American Indian or Alaska Native

o Asian

o Black or African American

o Native Hawaiian or Other Pacific Islander

o White

o Decline Response

13. To the best of my knowledge, the highest education level achieved by at least one of my parents is:

o High School Not Completed

o High School Diploma or Equivalent

o Some College-Level Work Completed

o Technical Certificate or Diploma

o Associate's Degree

o Bachelor's Degree

o Graduate Degree

o Do not know

14. While in high school, I was eligible for the Free/Reduced Price Lunch Program:

o Yes

o No

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