Name:

Do you have another job?  YES       NO 

If yes, where:  

New Title 

Old Salary       New Salary 

Additional Fringe Benefits New Position Offers: 

Did you get along well with your supervisor?  YES             NO 

If no, please explain:

How well did your supervisor handle any complaints or grievances you may have had? 

How did you feel about your salary?  

How did you feel about your progress within the Department?

What did you like best about your job?  

What did you dislike about your job?   

Specifically, why are you leaving? 

Would you stay if a more satisfactory arrangement could be worked out? If yes, explain:

What recommendations do you have for making this school or activity center a better place to work?