Sample -- Exit Interview

Name: ________________________________________ Date: _______________

How I feel I have benefited from this program: ___________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

What I liked the most: ______________________________________________________

_______________________________________________________________________

_______________________________________________________________________

What I would change: _______________________________________________________

_______________________________________________________________________

_______________________________________________________________________

What advice would you give others registering for this program?

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

Would you recommend this program to others? Why? Why not? ______________________

_______________________________________________________________________

_______________________________________________________________________

Have your interests changed or have new interests developed for you, from being in the program?

_______________________________________________________________________

_______________________________________________________________________

How has your child benefited by coming to the program? ____________________________

_______________________________________________________________________

_______________________________________________________________________

Have your child's interests changed developed in the way s/he is at home (drawing, books, etc)?

_______________________________________________________________________



PREVIOUS PAGE TABLE OF CONTENTS NEXT PAGE