EHS Transition Questionnaire Form 2013

East Anchorage High School

Student Transition Questionnairre

Today's Date

Your Contact Information

What’s your full name?

Student ID

Gender

Male Female

School Year

My Age Today Is

What’s an e-mail address that you check often?

If you need help with setting up an E-Mail Acount, then please come and see me in S8.

Confirm

Please provide a phone number we can reach you at!

Example: 9077422329

My Counselor Is

My IEP Case Manager Is

My IEP Expires On

Not sure, give me a call at 742-2329 (schl) or 345-1839 (home).

Your Availability

What’s the best way we can reach you?

Please e-mail me I prefer a phone call I can be contacted by phone or e-mail

Parents / Guardians Information

Last, First

Phone (Parent or Guardian 1)

Example: 9077422329

Last, First

Phone (Parent or Guardian 2)

Example: 9077422329

Our school staff is focused on helping you achieve your life goals and ambitions. Because success takes careful planning, please take your time to honestly evaluate your skills and interests, so we can better assist you in making a smooth transition to life beyond high school.

My Career: Four jobs I am considering, (Complete 2 minimum)

Job # 1

Job # 2

Job # 3

Job # 4

Postsecondary Education: After high school, I plan to (Please complete at least one, maybe two of the following choices!)

go to a university / community college - where?

go to a vocational / technical school - where?

go directly into the workforce - where?

enter the armed services - which branch?

begin a union apprentice program - which trade?

other (Please Specify)

Work Experience

My Current Job Status

I have a Job! I need help finding a job! I have never been employed!

I am presently working at

Previously employed by

A. If employed, have you completed any of the following?

Check All That Apply

I am signed up for Work Exp. Credit I have an up-to-date Resume' I have turned in Pay Stubs I have earned Work Exp. Credit (.5 Credit for every 115 Hours of Work) I have a Food Handler's Card I am First Aid / CPR Trained

Vocational Info: Please tell me about the ones I check below!

Check All That Apply

KCC - King Career Center Job Corps - Palmer, Alaska AVTEC - Alaska CRR - Career Resource Room Armed Services Apprenticeship Opportunities Your Occupational Skills Your Interest & Abilities MYA - Military Youth Academy

other (Please Specify)

Postsecondary Living Arrangements:

A. After earning my high school diploma I plan to
(Please complete one of the Following Choices)

live with my parents until

live on my own in

live with a roommate in

live in a home provided by

B. Ten years after graduation from high school, do you plan to be living independently "not with your family" and paying all your own bills?

Choose one of the following:

Transportation: How do you get around?

Check All That Apply

I have a Driver's License. I have a Driver's Permit. I have a Bike. I Walk. I use People Mover. I use a Taxi. Parents, Guardians, or other family members transport me. I have a MotorCycle.

A. No license or permit yet! When do you plan on obtaining them?

Driver's Permit

Driver's License

Recreation & Leisure Time Activities I Enjoy!

Athletics (Which Ones?)

Music (What Type?)

Dance (What Style?)

Volunteer Work (Where?)

Clubs (Please Describe!)

Religous Avtivities (Please Describe!)

My Hobbies Are?

My Outdoor Activities Include

Other (Please Specify!)

A. In 10 years, what free time activities would you like to be participating in?

Free TIme Choice # 1

Free TIme Choice # 2

B. What do you like best about high school?

My # 1 Like Is

My # 2 Like Is

C. What do you worry about most as a student trying to earn a high school diploma?

My # 1 Worry Is

My # 2 Worry Is

D. What is one thing that most of your friends and teachers do not know about you?

Most do not know that I

Testing I have Completed!

I have taken the following TEST

Thanks for taking the time to complete this questionnaire. Before clicking the "SUBMIT" button, please look over your responses and make sure you are happy with all of your input. Once again - Thank You Very Much!

Mr. Brown / SLC Teacher
East Anchorage High School
Email: brown_pat@asdk12.org
907-742-2240 / Classroom SE 30
907-345-1839 / Home

Please print a copy for your records!
This form will be deleted in 1 week!

Updated Sept. 15, 2014 (PB)

This form is currently in testing mode.

East Anchorage High School

Student Transition Questionnairre

Your Contact Information

Parents / Guardians Information

My Career: Four jobs I am considering, (Complete 2 minimum)

Postsecondary Education: After high school, I plan to (Please complete at least one, maybe two of the following choices!)

Work Experience

Vocational Info: Please tell me about the ones I check below!

Postsecondary Living Arrangements:

Transportation: How do you get around?

Recreation & Leisure Time Activities I Enjoy!

Testing I have Completed!