OMB Control No.: xxxx-xxxx Expiration Date: xx/xx/xxxx

(5-31-12)

This survey is authorized by law (xxxx).

We want you to know that:

1. We are asking you these questions in order to gather information about your 

educational and work experiences.

2. Please be assured that all information you provide will be kept confidential. Using the 

Login Identification Number and Password ensures that the information you provide to 

the study will be protected and will only be seen by selected members of the study 

team. The next page provides you with general information about the survey. You may 

skip any questions you do not wish to answer. However, we hope that you answer as 

many questions as you can.

As a thank you for participating in the survey, we would like to send you $15 if completed by 

Web and $10 if completed by phone or paper.

For questions, call toll free at (xxx) xxx-xxx or email xxxxxxx@yyyyyyyy.com

You may complete the survey one of three ways:

Receive $15 Receive $10 Receive $10

COMPLETE SURVEY BY WEB OR COMPLETE THIS PAPER 

SURVEY AND RETURN

OR CALL XXXX IF YOU WANT TO 

BE INTERVIEWED OVER THE 

TELEPHONE

Log on at:

https://www.xxxxxx.org and 

enter your user ID and password

Mail to:

Xxx Yyyy, Survey Director,

Survey of Recent Program 

Applicants

Contact info:

Use the enclosed pre-addressed 

postage paid envelope

Call:

Company toll free at: (xxx) xxx-xxx

and ask for the

Survey of Recent Program 

Applicants

Per the policies and procedures required by the Education Sciences Reform Act of 2002, Title I, Part E, Section 183, responses to this 

data collection will be used only for statistical purposes. The reports prepared for this study will summarize findings across the sample 

and will not associate responses with an individual. We will not provide information that identifies you to anyone outside the study team, 

except as required by law. Any willful disclosure of such information for nonstatistical purposes, without the informed consent of the 

respondent, is a class E felony.

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it

displays a valid OMB control number. The valid OMB control number for this information collection is XXXX-XXXX. The time 

required to complete this information collection is estimated to average 15 minutes per respondent, including the time to review 

instructions, and complete and review the information collected.

BARCODE LABEL

Survey of Recent Program Applicants
WHO/WHICH AGENCY IS SPONSORING THE STUDY? This study is being sponsored by the U.S. Department of 

Education.

WHO IS CONDUCTING THE STUDY? The study is being conducted by a team of researchers at XXXX under contract 

to the U.S. Department of Education.

WHAT IS THE PURPOSE OF THE STUDY? Our goal is to learn about how program applicants are doing. It will allow 

us to understand what works well and what doesn’t.

NO LONGER IN PROGRAM/NEVER PARTICIPATED. We are contacting people who signed up to participate, even if 

they never attended the educational or training program, or are no longer participating. 

[IF LESS THAN 18 YEARS OF AGE: The consent form your parents signed mentioned we would be contacting you to 

conduct an interview.]

HOW DID YOU GET MY NAME? After you applied to the [PROGRAM at INSTITUTION], and were offered your 

financial aid package, you were scientifically selected from among persons in your program to participate in the study.

I GOT A JOB SOON AFTER I APPLIED. That is wonderful, but we would like to talk to people who didn’t enroll in a 

program as well as those who did.

IS THE SURVEY CONFIDENTIAL? Yes. Your responses are protected from disclosure by federal statue [P.L. 107-347, 

Title V Confidential Information Protection and Statistical Efficiency Act of 2002 (CIPSEA)]. Your answers will be 

combined with those of others and your name will never be used in reporting the results of the study. Your answers to 

questions will not affect your eligibility for any public program.

[I DON’T HAVE THE TIME. TELEPHONE ONLY: We can schedule a call to conduct the survey at your convenience. Our 

interviewers are available to speak with you seven days a week as follows: on Mondays through Thursdays from 9:00 A.M.

to 12:00 midnight, on Fridays from 9:00 A.M. to 8:00 P.M., Saturdays from 9:00 A.M.-5:00 P.M. and Sundays from 1:00 P.M.

to 9:00 P.M. Eastern Standard Time. We can also complete the survey in more than one call, if necessary.]

I’M NOT INTERESTED. Let me reassure you that we are not selling anything. The questions we ask are designed to help 

the U.S. Department of Education understand the lives of individuals who applied to participate in a program. There are 

no right or wrong answers. We’re interested in your experiences and opinions. Your answers will be combined with those 

of others and your name will never be included in any report. We will also mail you a check in the amount of $15 for 

completing over the Web or $10 for completing the survey by phone or hard copy.

HOW LONG WILL THIS TAKE? The length of the interview varies, but it usually takes about 15 minutes.

WHO GAVE YOU THE AUTHORITY TO CONDUCT THE STUDY? This study is being sponsored by the 

U.S. Department of Education and has been approved by the U.S. Office of Management and Budget under 

OMB control number XXXX-XXXX. Without this approval we would not be able to conduct this survey. Questions 

regarding any aspect of this survey may be directed to U.S. Department of Education, Washington, DC 20210, 

telephone number XXX-XXX-XXXX (this is not a toll-free number) or by email: xxx.xx@ed.gov.

WILL I BE PAID? Yes, we will mail you a check in the amount of $15 for completing over the Web or $10 for completing 

the survey by phone or hard copy. The check will be mailed within 2 weeks of completing the survey.

I’M ON THE NATIONAL “DO NOT CALL LIST/REGISTRY.” WHY ARE YOU CALLING ME? The do not call list or 

registry applies to telemarketing calls, not to calls like this one that are approved by the government. Lawmakers 

recognize the need for the public to participate in studies like this to learn how government programs are working and 

how to improve them. We will not sell you anything, nor will we ask for money. Your privacy will be respected, and your 

cooperation is appreciated. For more information on who is included and excluded on the do not call list, you can visit 

the website at www.donotcall.gov.

WHO CAN I CONTACT FOR MORE INFORMATION? For more information about the study, you can visit the U.S. 

Department of Education (ED) website at http://www.ed.gov/. You can also call XXX-XXX-XXXX and ask to speak to 

[NAME].

FREQUENTLY ASKED QUESTIONS (FAQs)
1

We received your name as someone who applied to [fill PROGRAM AT INSTITUTION] in [fill APPLICATION MONTH, YEAR]. The 

program may have informed you that you were selected to be part of a study for the U.S. Department of Education conducted 

by [fill COMPANY]. We are contacting you to see how you are doing and to learn about some of your experiences since you 

applied.

A1. At the time you applied to [fill PROGRAM AT INSTITUTION] in [fill APPLICATION MONTH/YEAR], what was the 

highest diploma, degree, or certification you had received?

Select one only

 1 □ No diploma, degree, or certificate

 2 □ Adult basic education (ABE) certificate

 3 □ General Educational Development (GED) credential or its equivalent

 4 □ High school diploma

 5 □ Vocational/technical certificate (less than 2 years)

 6 □ Associate’s degree (AS, 2 years)—vocational 

 7 □ Associate’s degree (AA, 2 years)—vocational

 8 □ Bachelor’s degree or equivalent (BA/BS, 4 years)

 9 □ Master’s degree or equivalent (MA/MS)

10 □ Doctoral degree (MD, PhD)

11 □ Other professional degree/certificate

99 □ Other (Specify)

____________________________________________________________

A2. Thinking back to [fill APPLICATION MONTH, YEAR], when you applied to [fill PROGRAM AT INSTITUTION], did you 

enroll in [fill PROGRAM AT INSTITUTION], enroll in some other educational or training program, or did you decide not 

to enroll in any educational or training programs?

Select one only

1 □ Enrolled in [fill PROGRAM AT INSTITUTION]

2□ Enrolled in other educational or training program

3□ Decided not to enroll in any educational or training programs GO TO D1, PAGE 8

A. PROGRAM SELECTION

GO TO A3, PAGE 2
2

A3. Now, we would like to know about all of the educational and training programs you have enrolled in since [fill 

APPLICATION MONTH, YEAR]. Please complete all of the questions on this table (pages 2 and 3).

A. Name of program, 

institution, city, and state.

B. What was/is the field 

of study? Please 

use codes below.

C. What type of certificate/degree you 

expect/expected to receive?

Select one only

D. Program Start 

and End Date

E. Method of 

Program Delivery

Select one only

1. _________________________

Name of Program

_________________________

Name of Institution

_________________________

City/State

We are interested in the name of the 

program, not a list of the courses you took 

within the program.

| | |

If 99 Other, (Specify)

_____________________

 1□ Vocational/technical certificate (< 2 years)

 2 □ Associate’s degree (AS, 2 years, vocational)

 3 □ Associate’s degree (AA, 2 years, academic)

 4□ Bachelor’s degree or equivalent (BA/BS, 4 

years)

 5□ Master’s degree or equivalent (MA/MS)

 6□ Doctoral degree (MD, PhD)

 7□ Other professional degree/certificate

99 □ Other (Specify)

START

| | | / | | | | |

 MONTH YEAR

END

 | | | / | | | | |

 MONTH YEAR

 1□ All in-person

 2 □ All online (i.e. using a 

computer without inperson instruction)

 3 □ Some in-person and 

some online

 4 □ Some in-person and 

some at a work/ 

business location

2. _________________________

Name of Program

_________________________

Name of Institution

_________________________

City/State

We are interested in the name of the 

program, not a list of the courses you took 

within the program.

| | |

If 99 Other, (Specify)

_____________________

 1□ Vocational/technical certificate (< 2 years)

 2 □ Associate’s degree (AS, 2 years, vocational)

 3 □ Associate’s degree (AA, 2 years, academic)

 4□ Bachelor’s degree or equivalent (BA/BS, 4 

years)

 5□ Master’s degree or equivalent (MA/MS)

 6□ Doctoral degree (MD, PhD)

 7□ Other professional degree/certificate

99 □ Other (Specify)

START

| | | / | | | | |

 MONTH YEAR

END

 | | | / | | | | |

 MONTH YEAR

 1□ All in-person

 2 □ All online (i.e. using a 

computer without inperson instruction)

 3 □ Some in-person and 

some online

 4 □ Some in-person and 

some at a work/ 

business location

3. _________________________

Name of Program

_________________________

Name of Institution

_________________________

City/State

We are interested in the name of the 

program, not a list of the courses you took 

within the program.

| | |

If 99 Other, (Specify)

_____________________

 1□ Vocational/technical certificate (< 2 years)

 2 □ Associate’s degree (AS, 2 years, vocational)

 3 □ Associate’s degree (AA, 2 years, academic)

 4□ Bachelor’s degree or equivalent (BA/BS, 4 

years)

 5□ Master’s degree or equivalent (MA/MS)

 6□ Doctoral degree (MD, PhD)

 7□ Other professional degree/certificate

99 □ Other (Specify)

START

| | | / | | | | |

 MONTH YEAR

END

 | | | / | | | | |

 MONTH YEAR

 1□ All in-person

 2 □ All online (i.e. using a 

computer without inperson instruction)

 3 □ Some in-person and 

some online

 4 □ Some in-person and 

some at a work/ 

business location

4. _________________________

Name of Program

_________________________

Name of Institution

_________________________

City/State

We are interested in the name of the 

program, not a list of the courses you took 

within the program.

| | |

If 99 Other, (Specify)

_____________________

 1□ Vocational/technical certificate (< 2 years)

 2 □ Associate’s degree (AS, 2 years, vocational)

 3 □ Associate’s degree (AA, 2 years, academic)

 4□ Bachelor’s degree or equivalent (BA/BS, 4 

years)

 5□ Master’s degree or equivalent (MA/MS)

 6□ Doctoral degree (MD, PhD)

 7□ Other professional degree/certificate

99 □ Other (Specify)

START

| | | / | | | | |

 MONTH YEAR

END

 | | | / | | | | |

 MONTH YEAR

 1□ All in-person

 2 □ All online (i.e. using a 

computer without inperson instruction)

 3 □ Some in-person and 

some online

 4 □ Some in-person and 

some at a work/ 

business location

FIELD OF STUDY CODES

 1 = Agriculture, natural resources, and related sciences

 2 = Architecture, planning, and related services

 3 = Area, ethnic, cultural, and gender studies

 4 = Arts—visual and performing

 5 = Biological and biomedical sciences

 6 = Business, management, marketing, and related support 

services

 7 = Communication, journalism, communication technologies, 

and related programs

 8 = Computer and information sciences and support services

 9 = Construction trades

10 = Cosmetology, funeral services, and culinary service

11 = Education

12 = Engineering, engineering technologies/technicians

13 = English language and literature/letters

14 = Family and consumer sciences/human sciences

15 = Foreign languages, literatures, and linguistics

16 = Health professions and related clinical sciences

17 = Legal professions and studies

18 = Liberal arts and sciences, general studies and humanities

19 = Library science

20 = Mathematics and statistics

21 = Mechanical and repair technologies/technicians

22 = Multi/interdisciplinary studies

23 = Parks, recreation, leisure and fitness studies

24 = Precision production 

25 = Philosophy, religion & theology

26 = Physical sciences

27 = Psychology

28 = Public administration and social service professions

29 = Science technologies/technicians

30 = Security & protective services

31 = Social sciences and history (except psychology)

32 = Transportation & materials moving

99 = Other

A. PROGRAM SELECTION (CON’T) 
3

F. What was/is your reason for applying/enrolling?

Select all that apply

G. Did you complete the 

program?

H. What were the reasons you stopped 

attending?

Select all that apply

1. 1 □ To gain new job or occupational skills

 2 □ To help move up in the job I already have

 3 □ To help me get a new job I’m interested in

 4 □ To prepare for occupational certification or work-related licensure

 5 □ To earn course credits needed for a program at a different school

 6 □ To take courses for recreation, self-improvement or personal interest

 7 □ To complete an undergraduate degree

99 □ Other (Specify)

___________________________________________________

 0 □ Stopped Attending

1□ Yes

GO TO NEXT PROGRAM 

OR B1

 2 □ Still Enrolled

GO TO NEXT PROGRAM 

OR B1

 1 □ Offered or got a good job

 2 □ Did not have money for tuition/cost of program

 3 □ Needed to work more so didn’t have enough time

 4 □ Did not expect to get a good job after completion

 5 □ Not satisfied with the quality of the program

 6 □ Program was too hard/did not have the right 

background to learn the new skills

 7 □ Physical, mental health, family, or personal reasons

 8 □ Was called to active duty/joined the armed forces

99 □ Other (Specify)

_______________________________________

2. 1 □ To gain new job or occupational skills

 2 □ To help move up in the job I already have

 3 □ To help me get a new job I’m interested in

 4 □ To prepare for occupational certification or work-related licensure

 5 □ To earn course credits needed for a program at a different school

 6 □ To take courses for recreation, self-improvement or personal interest

 7 □ To complete an undergraduate degree

99 □ Other (Specify)

___________________________________________________

 0 □ Stopped Attending

1□ Yes

GO TO NEXT PROGRAM 

OR B1

 2 □ Still Enrolled

GO TO NEXT PROGRAM 

OR B1

 1 □ Offered or got a good job

 2 □ Did not have money for tuition/cost of program

 3 □ Needed to work more so didn’t have enough time

 4 □ Did not expect to get a good job after completion

 5 □ Not satisfied with the quality of the program

 6 □ Program was too hard/did not have the right 

background to learn the new skills

 7 □ Physical, mental health, family, or personal reasons

 8 □ Was called to active duty/joined the armed forces

99 □ Other (Specify)

_______________________________________

3. 1 □ To gain new job or occupational skills

 2 □ To help move up in the job I already have

 3 □ To help me get a new job I’m interested in

 4 □ To prepare for occupational certification or work-related licensure

 5 □ To earn course credits needed for a program at a different school

 6 □ To take courses for recreation, self-improvement or personal interest

 7 □ To complete an undergraduate degree

99 □ Other (Specify)

___________________________________________________

 0 □ Stopped Attending

1□ Yes

GO TO NEXT PROGRAM 

OR B1

 2 □ Still Enrolled

GO TO NEXT PROGRAM 

OR B1

 1 □ Offered or got a good job

 2 □ Did not have money for tuition/cost of program

 3 □ Needed to work more so didn’t have enough time

 4 □ Did not expect to get a good job after completion

 5 □ Not satisfied with the quality of the program

 6 □ Program was too hard/did not have the right 

background to learn the new skills

 7 □ Physical, mental health, family, or personal reasons

 8 □ Was called to active duty/joined the armed forces

99 □ Other (Specify)

_______________________________________

4. 1 □ To gain new job or occupational skills

 2 □ To help move up in the job I already have

 3 □ To help me get a new job I’m interested in

 4 □ To prepare for occupational certification or work-related licensure

 5 □ To earn course credits needed for a program at a different school

 6 □ To take courses for recreation, self-improvement or personal interest

 7 □ To complete an undergraduate degree

99 □ Other (Specify)

___________________________________________________

 0 □ Stopped Attending

1□ Yes

GO TO NEXT PROGRAM 

OR B1

 2 □ Still Enrolled

GO TO NEXT PROGRAM 

OR B1

 1 □ Offered or got a good job

 2 □ Did not have money for tuition/cost of program

 3 □ Needed to work more so didn’t have enough time

 4 □ Did not expect to get a good job after completion

 5 □ Not satisfied with the quality of the program

 6 □ Program was too hard/did not have the right 

background to learn the new skills

 7 □ Physical, mental health, family, or personal reasons

 8 □ Was called to active duty/joined the armed forces

99 □ Other (Specify)

_______________________________________

A. PROGRAM SELECTION (CON’T) 
4

B1. There are many factors students may consider when choosing an educational or training program. For 

your most recent program, how important was each of the factors listed below in your decision to enroll 

in this program? Were these factors very important, somewhat important, or not important in your 

decision to choose the program?

Select one per row

VERY 

IMPORTANT

SOMEWHAT 

IMPORTANT

NOT

IMPORTANT

a. Quality of faculty/teachers 1□ 2□ 3□

b. Ability to reach or talk to faculty/teachers 1□ 2□ 3□

c. Opportunities for hands-on learning 1□ 2□ 3□

d. Skills taught seemed very related to desired job, promotion, or industry 

certification 1□ 2□ 3□

e. Availability/quality of career counseling/case management 1□ 2□ 3□

f. Availability/quality of work readiness training (e.g. resume writing, job 

interviewing, career information) 1□ 2□ 3□

g. Job placement assistance 1□ 2□ 3□

h. Academic advising/support 1□ 2□ 3□

i. Availability of financial aid, such as loans, scholarships, or grants 1□ 2□ 3□

j. Convenience of location 1□ 2□ 3□

k. Convenience of time when classes are offered 1□ 2□ 3□

l. Duration of program 1□ 2□ 3□

m. Availability of an internship as part of the program 1□ 2□ 3□

n. Recommended by a friend, relative, or advisor 1□ 2□ 3□

B. EXPERIENCE WITH THE MOST RECENT OR MOST RECENTLY COMPLETED PROGRAM
5

B2. Considering these same factors, please rate your satisfaction with the most recent education or training 

program you attended. Would you say you are/were very satisfied, somewhat satisfied, somewhat 

dissatisfied, or very dissatisfied?

Select one per row

VERY 

SATISFIED

SOMEWHAT 

SATISFIED

SOMEWHAT 

DISSATISFIED

VERY 

DISSATISFIED

a. Quality of faculty/teachers 1□ 2□ 3□ 4□

b. Ability to reach/talk to faculty/teachers 1□ 2□ 3□ 4□

c. Opportunities for hands-on-learning 1□ 2□ 3□ 4□

d. Appropriateness of skills taught to desired job, promotion, or industry 

certification 1□ 2□ 3□ 4□

e. Availability and/or quality of career counseling/case management 1□ 2□ 3□ 4□

f. Work readiness (e.g. resume writing, job interviewing) and career 

information 1□ 2□ 3□ 4□

g. Job search/placement assistance 1□ 2□ 3□ 4□

h. Academic advising/support 1□ 2□ 3□ 4□

i. Availability of financial aid, such as loans, scholarships, or grants 1□ 2□ 3□ 4□

o. geographic location/convenience 1□ 2□ 3□ 4□

B3. Overall, how would you rate your most recent education/training program?

0□ Excellent

1□ Good

2□ Fair

3□ Poor

B4. Have you received career counseling, work readiness, or job search assistance from any other person 

or organization outside your most recent educational or training program since [fill APPLICATION MONTH, 

YEAR]?

Select all that apply

Work readiness 

(e.g. resume writing, job 

interviewing) and career 

information

Job search/placement 

assistance

Career counseling/case 

management

a. College Career Center 1□ 2□ 3□

b. Government Agency 1□ 2□ 3□

c. Local/community workforce development center or 

organization (e.g. one-stop career center) 1□ 2□ 3□

d. Community based or neighborhood organization 1□ 2□ 3□

e. High school advisor 1□ 2□ 3□

B. EXPERIENCE WITH THE MOST RECENT OR MOST RECENTLY COMPLETED PROGRAM (CON’T)
6

B4. Have you obtained a professional certification or a state or industry license? A professional 

certification or license shows you are qualified to perform a specific job and includes things like Certified 

Medical Assistant, commercial truck driving, automotive technician, or an IT certification (e.g., Cisco, 

networking, security technology, etc.).

1 □ Yes

0□ No GO TO C1, PAGE 7

B5. What is the name of any certification(s) or license(s) and what type of credential is it?

Select one per row

A. Name of credential B. Industry Certification C. State License D. Other

1. 1 □ 2 □ 3□

2. 1 □ 2 □ 3□

3. 1 □ 2 □ 3□

B. EXPERIENCE WITH THE MOST RECENT PROGRAM (CON’T) 
7

The next few questions are designed to help us understand how students pay for expenses to attend 

educational and vocational training programs. 

C1. Please think about all of the educational and training programs you may have attended since [fill 

APPLICATION MONTH/YEAR]. What was the total cost of your tuition to attend the program(s)?

Please include room and board if you had this expense.

Please include any costs covered by financial aid, grants, loans or scholarships.

$ | | | | , | | | | . | 0 | 0 |

C2. Now we would like to know the different funding sources you used to cover your costs in attending 

all these educational and training programs and how the availability of the funding source affected your 

choice to enroll.

Select one per row

Funding Source

Did you receive 

funds?

If yes, how much of your overall 

spending did it cover?

If you had not received 

funding from this source, 

would you have enrolled in 

these programs?

GRANTS (Financial aid that does not need to be paid back)

a. Federal Pell Grants 1 □ Yes

0 □ No

d □ I don’t know

1 □ Less than 1/4

2 □ More than 1/4 but less than 1/2

3 □ About 1/2

4 □ More than 1/2

1 □ Yes

0 □ No

d □ I don’t know

b. Other federal/state/school 

grants

1 □ Yes

0 □ No

d □ I don’t know

1 □ Less than 1/4

2 □ More than 1/4 but less than 1/2

3 □ About 1/2

4 □ More than 1/2

1 □ Yes

0 □ No

d □ I don’t know

c. Job training vouchers or 

Individual Training Accounts

from local One-Stop Center 

or workforce development 

agency

1 □ Yes

0 □ No

d □ I don’t know

1 □ Less than 1/4

2 □ More than 1/4 but less than 1/2

3 □ About 1/2

4 □ More than 1/2

1 □ Yes

0 □ No

d □ I don’t know

d. Grants or tuition 

reimbursement from your 

employer

1 □ Yes

0 □ No

d □ I don’t know

1 □ Less than 1/4

2 □ More than 1/4 but less than 1/2

3 □ About 1/2

4 □ More than 1/2

1 □ Yes

0 □ No

d □ I don’t know

LOANS (Financial aid that needs to be paid back)

e. Federal/state/school loans 1 □ Yes

0 □ No

d □ I don’t know

1 □ Less than 1/4

2 □ More than 1/4 but less than 1/2

3 □ About 1/2

4 □ More than 1/2

1 □ Yes

0 □ No

d □ I don’t know

f. Loans from private banks 1 □ Yes

0 □ No

d □ I don’t know

1 □ Less than 1/4

2 □ More than 1/4 but less than 1/2

3 □ About 1/2

4 □ More than 1⁄2

1 □ Yes

0 □ No

d □ I don’t know

SCHOLARSHIPS (Financial aid awarded based on merit or status—e.g. because you are citizen of state, member of church, etc.)

g. Scholarships 1 □ Yes

0 □ No

d □ I don’t know

1 □ Less than 1/4

2 □ More than 1/4 but less than 1/2

3 □ About 1/2

4 □ More than 1/2

1 □ Yes

0 □ No

d □ I don’t know

C. PAYING FOR EDUCATION AND TRAINING PROGRAMS
8

Select one per row

Funding Source Did you receive 

funds?

If yes, how much of your overall 

spending did it cover?

If you had not received 

funding from this source, 

would you have enrolled in 

this program?

OTHER

h. From Veteran’s Benefits 

(including GI Bill)

1 □ Yes

0 □ No

d □ I don’t know

1 □ Less than 1/4

2 □ More than 1/4 but less than 1/2

3 □ About 1/2

4 □ More than 1/2

1 □ Yes

0 □ No

d □ I don’t know

i. Gifts from family and friends 1 □ Yes

0 □ No

d □ I don’t know

1 □ Less than 1/4

2 □ More than 1/4 but less than 1/2

3 □ About 1/2

4 □ More than 1/2

1 □ Yes

0 □ No

d □ I don’t know

j. My savings 1 □ Yes

0 □ No

d □ I don’t know

1 □ Less than 1/4

2 □ More than 1/4 but less than 1/2

3 □ About 1/2

4 □ More than 1/2

1 □ Yes

0 □ No

d □ I don’t know

k. Credit Cards 1 □ Yes

0 □ No

d □ I don’t know

1 □ Less than 1/4

2 □ More than 1/4 but less than 1/2

3 □ About 1/2

4 □ More than 1/2

1 □ Yes

0 □ No

d □ I don’t know

C3. Overall, about what portion of the total cost of the programs would you say you will pay through 

student loans offered to you from schools, banks, or other organizations?

Please do not include money that you borrowed from friends or family.

1 □ None 

2 □ Less than 1/4

3 □ More than 1/4 but less than 1/2

4 □ About 1/2

5 □ More than 1/2

C4. Right now, how much do you still owe in student loans or credit card payments used to cover tuition? 

$ | | | | , | | | | . | 0 | 0 |

GO TO C5

C. PAYING FOR ALL EDUCATIONAL AND TRAINING PROGRAMS (CON’T) 
9

C5. We are also interested in learning about financial assistance you may have received to help you with 

other expenses (not including tuition and fees) to attend any educational or training programs?

Since [fill APPLICATION MONTH, YEAR], have you received assistance in the form of cash, vouchers, 

gift cards, or reimbursement to help you pay for any of the following:

(Please do not include financial assistance you may have received from friends or family.)

Select one per row

YES NO

a. Books? 1□ 0 □

b. Tools or other supplies? 1□ 0 □

c. Clothes or other uniforms? 1□ 0 □

d. Transportation such as gas cards or bus passes? 1□ 0 □

e. Child care? 1□ 0 □

GO TO E1, PAGE 11

C. PAYING FOR ALL EDUCATIONAL AND TRAINING PROGRAMS (CON’T) 
10

ONLY COMPLETE SECTION D IF YOU DID NOT ATTEND ANY EDUCATIONAL PROGRAM 

SINCE [fill PROGRAM AT INSTITUTION]

D1. How important was each of the following factors in your decision to not attend any educational or 

training program since [fill PROGRAM AT INSTITUTION]?

Select one per row

MAJOR 

FACTOR

MINOR 

FACTOR

NOT A

FACTOR

a. Offered or got a good job 1□ 2□ 3□

b. Did not have money for tuition/cost of program 1 □ 2□ 3 □

c. Needed to work more so didn’t have enough time for program 1 □ 2□ 3 □

d. Did not expect to get a good job after completing the programs I knew 

about 1 □ 2□ 3 □

e. Was not satisfied with the quality of the program 1 □ 2□ 3 □

f. Was undecided about which course of study to pursue 1 □ 2□ 3 □

g. Did not think I had the right background to learn the new occupational/ 

vocational skills 1 □ 2□ 3 □

h. Family reasons (e.g. needed to take care of family member, had child) 1 □ 2□ 3 □

i. Had physical or mental health challenges 1 □ 2□ 3 □

j. Other personal reasons (e.g. other interests besides school) 1 □ 2□ 3 □

k. I was called to active duty and/or I joined one of the armed forces/military 1 □ 2□ 3 □

D. REASONS FOR NOT ATTENDING EDUCATIONAL OR TRAINING PROGRAM(S)
11

E1. Which of these conditions describes your main activity during the week?

Select one only

 1□ Working

 2□ Seeking employment

 3□ Caring for children or other relatives at home without pay 

 4□ Volunteering at least 20 hours per week

 5 □ Part-time student

 6□ Full-time student

 7□ Medical or maternity leave

 8□ Something else (Specify)______________________________

E2. How many hours do you work in a typical week?

Enter “0” if not currently employed

| | | |

E2a. Using the list of occupations, please select the code that best describes your current job or most recent 

job if you’re not currently employed. If you are currently holding more than one job, select the 

occupation where you work the most hours.

Select one only

| | |

LIST OF OCCUPATIONS 

To make sure you have found the best code, please review all occupations before making your choice.

1 Management 12 Protective Service

2 Business and Financial 13 Food Preparation and Serving Related

3 Computer and Mathematical 14 Building and Grounds Cleaning and Maintenance

4 Architecture and Engineering 15 Personal Care and Service

5 Life, Physical, and Social Science 16 Sales and Related

6 Community and Social Services 17 Office and Administrative Support

7 Legal 18 Farming, Fishing, and Forestry

8 Education, Training, and Library 19 Construction and Extracting

9 Arts, Design, Entertainment, Sports, and Media 20 Installation, Maintenance, and Repair

10 Healthcare Practitioners and Technical 21 Production

11 Healthcare Support 22 Transportation and Material Moving

E2b. In what month and year did you begin working at this job (current or most recent) for pay?

| | | / | | | | |

MONTH YEAR

E. EMPLOYMENT STATUS
12

E3. How much do you currently earn per hour at this job or did or did you earn in your most recent job?

Your best estimate is fine.

Select one only

1 □ $7.25 or less

2□ $7.26 - $10.00

3□ $10.01 - $13.00

4□ $13.01 - $16.00

5□ $16.01 - $19.00

6□ $19.01 - $23.00

7□ $23.01 - $25.00

8□ $25.01 or more

E4. Thinking about your current job, please rate your satisfaction with the job’s benefits such as . . . 

Select one per row

VERY 

SATISFIED

SOMEWHAT 

SATISFIED

SOMEWHAT 

DISSATISFIED

VERY 

DISSATISFIED

a. Salary 1 □ 2 □ 3 □ 4 □

b. Healthcare benefits 1 □ 2 □ 3 □ 4 □

c. Pension/retirement benefits 1 □ 2 □ 3 □ 4 □

d. 401K/IRA 1 □ 2 □ 3 □ 4 □

e. Job Security 1 □ 2 □ 3 □ 4 □

f. Opportunities for additional or specialized training 1 □ 2 □ 3 □ 4 □

g. Opportunities for advancement/promotion 1 □ 2 □ 3 □ 4 □

h. Intellectual challenge 1 □ 2 □ 3 □ 4 □

i. Level of responsibility 1 □ 2 □ 3 □ 4 □

j. Contribution to society 1 □ 2 □ 3 □ 4 □

k. Ability to use skills you learned from education 

and training 1 □ 2 □ 3 □ 4 □

E. EMPLOYMENT STATUS (CON’T) 

IF CURRENTLY UNEMPLOYED GO TO F1, PAGE 13, OTHERWISE CONTINUE.
13

E5. Who was most helpful to you in getting your current job?

Select one only

1 □ No one, I got the position on my own

2□ Counselors, teacher, or other staff at the most recent education or training 

program I attended

3□ College/school career center

4□ A government agency

5□ Local/community workforce development center or organization (e.g. One-Stop 

Career Center)

6□ Community base or neighborhood organization

7□ High school advisor

8□ Family/relatives (e.g. parents, guardians)

9□ Previous employer

10□ Friends

E6. To what extent is the work you do on your current job related to any education or training you may have 

received since [fill APPLICATION MONTH/YEAR]?

Select one only

1 □ Closely related to a training program I attended/am attending

2□ Somewhat related to a training program I attended/am attending

3□ I did not attend a training program, so work not at all related

4□ I did attend a training program, but work not at all related 

E7. Did any of these factors influence your decision to work in an area outside the program field you 

applied for in [fill APPLICATION MONTH/YEAR] which was [fill PROGRAM AT INSTITUTION]?

Select one per row

YES NO

a. Pay, promotion opportunities 1□ 0 □

b. Working conditions (e.g. hours, equipment, working environment) 1□ 0 □

c. Job location 1□ 0 □

d. Change in career or interests 1□ 0 □

e. Family-related reasons (e.g. children, spouse’s job moved) 1□ 0 □

f. Job in program field not available 1□ 0 □

g. Some other reason (Specify) 1□ 0 □

________________________________________________________

E. EMPLOYMENT STATUS (CON’T) 

GO TO F1, PAGE 13
14

F1. Do you plan on enrolling in any other educational or vocational training programs in the future?

 1 □ Yes

 0 □ No GO TO G1, PAGE 15

F2. What type of degrees or certification programs and in what fields of study do you plan on pursuing?

Please use the codes below to complete table.

SELECT ONE CODE PER ROW

a. Vocational/technical certificate (less than 2 years) | | |

b. Associate’s degree (AS, 2 years, vocational) | | |

c. Associate’s degree (AA, 2 years, academic)

d. Bachelor’s degree or equivalent (BA/BS, 4 years) | | |

e. Master’s degree or equivalent (MA/MS) | | |

f. Doctorate/Ph.D. (MD, PhD) | | |

g. Other professional degree/certificate (Specify) | | |

________________________________________________________

h. Some other (Specify) | | |

________________________________________________________

FIELD OF STUDY CODES

 1 = Agriculture, natural resources, and related 

sciences

 2 = Architecture, planning, and related services

 3 = Area, ethnic, cultural, and gender studies

 4 = Arts—visual and performing

 5 = Biological and biomedical sciences

 6 = Business, management, marketing, and related 

support services

 7 = Communication, journalism, communication 

technologies, and related programs

 8 = Computer and information sciences and support 

services

 9 = Construction trades

10 = Cosmetology, funeral services, and culinary 

service

11 = Education

12 = Engineering, engineering 

technologies/technicians

13 = English language and literature/letters

14 = Family and consumer sciences/human sciences

15 = Foreign languages, literatures, and linguistics

16 = Health professions and related clinical sciences

17 = Legal professions and studies

18 = Liberal arts and sciences, general studies and 

humanities

19 = Library science

20 = Mathematics and statistics

21 = Mechanical and repair technologies/technicians

22 = Multi/interdisciplinary studies

23 = Parks, recreation, leisure and fitness studies

24 = Precision production 

25 = Philosophy, religion & theology

26 = Physical sciences

27 = Psychology

28 = Public administration and social service 

professions

29 = Science technologies/technicians

30 = Security & protective services

31 = Social sciences and history (except psychology)

32 = Transportation & materials moving

99 = Other

F. FUTURE GOALS
15

These last questions ask for some general 

demographic information.

G1. In what year were you born?

| | | | | YEAR

G2. Are you Hispanic or Latino?

1 □ Yes

0□ No

G3. What is your race?

Select all that apply

1 □ White

2□ Black or African American

3□ Asian

4□ Native Hawaiian or Other Pacific Islander

5□ American Indian or Alaska Native

G4. Are you...

1 □ Male

2□ Female

G5. Do you have any children under 18? 

Include birth, adopted, foster, or 

stepchildren.

1 □ Yes

2□ No

G6. What is your marital status as of today?

Select one only

1 □ I am single

2□ I am married/remarried

3□ I am separated

4□ I am divorced or widowed

G7. We will be mailing you a check in a couple of 

weeks and we would like to confirm the spelling 

of your name and address where we should send 

the payment.

_________________________________________

FIRST NAME

_________________________________________

MIDDLE INITIAL/NAME

_________________________________________

LAST NAME

_________________________________________

STREET 1

_________________________________________

STREET 2

_________________________________________

APT. #

_________________________________________

CITY

_________________________________________

STATE

_________________________________________

ZIP

G8. Thank you for participating in the survey and 

providing your address. Please provide your 

telephone number and email address because 

we may need to contact you again in the future.

| | | | - | | | | -| | | | |

 AREA CODE

_________________________________________

EMAIL

G. BACKGROUND AND CONTACT INFORMATION
16