Alumni Survey

Name:__________________________________________________________________

Place of Employment:____________________________________________________________

Position:________________________________________________________________

Home Address:________________________________________________________________

City ___________________________________   State ____________   ZIP _________

Phone (Work)_____________ (Home)______________ E-Mail_____________________

When hired:____________________    When began:____________________________

Approximate Salary:_____________________       Hours:________________________

Private:______________  For Profit:_________________  Public:__________________

Type of patient population:______________________________________________________________

Did curriculum prepare you for the position?   Yes ____________   No ______________

Did practical experience prepare you for the position?  Yes _______   No ____________

Did seminars prepare you for the position?       Yes ___________   No ______________

Strengths of Program________________________________________________________________

_______________________________________________________________________

Limitations of Program _______________________________________________________________________

_______________________________________________________________________

Improvements Needed _______________________________________________________________________

_______________________________________________________________________

Year Graduated __________________________   

Enrolled in Doctoral Program________________

Are you certified__________________________