CAREER/TECHNICAL EDUCATION STUDENT PLACEMENT STATUS
These data are required for program improvement and reporting activities. Part I is to be completed when
a student enters the program. Part II is to be completed when a student exits the program. Data on race,
sex and disabilities will be aggregated and used for reporting purposes only.
PROGRAM NAME: AVIONICS TECHNOLOGY SEMESTER: SUMMER 2008
PART I. STUDENT DEMOGRAPHIC DATA AND EMPLOYMENT STATUS – PROGRAM ENTRY
A. Student Demographic Data
Name _____________________________________ Date _____________ Student ID ________________________
Addresss_______________________________________________________________________________________
Sex:
□ Male
Veteran:
□ Female
□ Yes □ No
Pell Grant:
Americans with Disabilities Act:
□ Yes □ No
□ 0-5
How many semester hours are you taking?
Scholarship:
□ Yes □ No
□ 6-11
□ 12+
□ Yes □ No
VA:
□ Yes □ No Chapter:_______
B. Student Employment at Time of Program Entry
Are you:
□ Employed in an aviation field.
□ Not employed.
□ Employed in a non-aviation field.
□ Dislocated worker.
Employer Name ______________________________________ Employer City ______________________________
Occupation __________________________________________ Are you:
□ Full-time
□ Part-time
PART II. STUDENT COMPLETION, EMPLOYMENT AND EDUCATION STATUS – PROGRAM EXIT
Semester Program Completed ____________________
Mark the ONE completion category that applies:
□ Program Graduate
□ Alternative completer (completed 15 semester hours in program, related employment 40 hours per week)
□ Non-completer/did accomplish purpose for enrollment
□ Non-completer/did not accomplish purpose for enrollment
Passed licensure exam?
□ Yes □ No □ Not Applicable
Are you currently employed? □ Yes □ No
If yes, is your field of employment:
□ Aviation related
□ Non-aviation related
Employer ______________________________
Name of licensure exam (if applicable): ____________
If no, are you:
□ Actively seeking employment
□ Not seeking employment
□ Unavailable for employment due to illness/injury
City ___________________________________
Did you enter the military? □ Yes □ No
Are you (choose one):
□ Pursuing education related to aviation
□ Pursuing education not related to aviation
□ Not pursuing additional education
_________________________________________________________
Signature of person completing Part II
_____________________________
Date of Part II completion