César E. Chávez Leadership Institute

CCLI Alumni Questionnaire

The purpose of this questionnaire is to answer questions regarding your post-high school education experience. The Cesar Chavez Leadership Institute uses this information to demonstrate the effectiveness of the program and track the success of former CCLI students.

All information gathered is confidential and in adherence to ASU Privacy Policy.

Fields marked with a "*" are required.

Name & CCLI Class
Name*
(First/Middle/Last)
First:
Middle:
Year You
Attended CCLI*
Demographics
Birthdate: (MM/DD/YYYY)
Gender:
Ethnicity:

 

If you entered "Other," please enter your answer here:

High School Career
Last High School
You Attended
HS Name:
City:
State:
Date You Left
High School

Month:

Year:

Did you graduate from High School?
No Earned GED

 

If you answered "No," click here to skip College Career questions.
College Career

Are you currently attending a trade school, college or university?
No Have Graduated

 

If you answered "No," click here to skip College Career questions.
If yes, what school are you currently attending?
School Name:
City:
State:
What type of degree(s) are you pursuing?
(ie, Bachelor of Arts, Bachelor of Science, etc...)
What is your major or field of study?
Date you entered this school:

Month:

Year:

Date you graduated, or expect to graduate, from this school:

Month:

Year:

Current grade level:
Is this the only school you have attended since graduating from high school?
(including trade schools, colleges or universities, if applicable)
If you attended other trade schools, colleges or universities prior to your current school, please list them along with attendance dates.
(Please write out the name of the school.)
College Housing
While attending trade school, college or university, where did you live?
(check all that apply)
Other
College Activities, Awards and Financial Aid

Please list any student activities you participated in while attending trade school, college or university.
Please list any honors or awards you received while attending trade school, college or university.
Did you receive any of these financial aid awards?
(check all that apply)
Pell Grant
Academic Competitiveness Grant (ACG)
National Science and Mathematics Access to Retain Talent Grant (National SMART Grant)
Teacher Education Assistance for College and Higher Education Grant (TEACH grant)
Stafford Loan
PLUS Loan
Supplemental Educational Opportunity Grant
Work Study
Perkins Loan
Did you receive any scholarships?
No
If yes, please list scholarships you have received:
Work History - Did you work during school?

While attending trade school/college/university are you or were you employed?
No

 

If you answered "No," click here to skip Work History questions.
If yes, did you work:
On average how many hours per week did you work while attending trade school, college or university? hrs per week
Contact Information
Permanent Mailing Address*
Street Address*
Apartment Number
City*
State*
Zip Code*
Current Mailing Address Check here if address is same as above and skip to telephone
Street Address
Apartment Number
City
State
Zip Code
Home Telephone*
Cell Telephone include Area Code
Personal or
Home E-mail
(non-college)
Your E-mail at School
(if applicable)
Do you have an account on Facebook?
No
Comments (optional)

Let us know if you have any questions, concerns, or thoughts regarding this survey or CCLI here.

If you would rather send a separate e-mail, go to our Contact page.
Thank you!

Thank you for taking part in our survey.

Once complete, click the "Submit" button.
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