* = Required Information
Name of Student
Name of Program
Name of Instructor
Telephone Number (cell)
Telephone Number (home)
Rate your learning experience at Stein Academy using a scale of 1 to 5. (1 for poor and 5 for excellent)
Rate the instructor using a scale of 1 to 5. (1 for poor and 5 for excellent)
Who was/were your instructor(s) at Stein?
What can we do better? Please list
CURRENT EMPLOYMENT STATUS
Where do you currently work?
Name of Company/Organization/Employer
Your Title or Position
How long have you worked with this company/organization?
Date you were hired or Date you started Work
About how much do you make an hour or how much do they start workers in your position (You can approximate the amount)?
Your Work or Employer’s Phone Number
Name of your Immediate Supervisor
Date of Survey
THANK YOU FOR YOUR TIME & ASSISTANCE
We collect some of these information to satisfy State requirements. All information provided are kept private. We do not share student information and we do not contact your employers.