Survey Templates School Surveys High School Dropout Questionnaire & Sample Survey Template

High School Dropout Questionnaire & Sample Survey Template

This free high school dropout questionnaire can be used in your surveys to help collect demographic information, as well as understand the reasons for high school student dropouts. The survey questions in this sample survey template are designed to draw conclusions about the dropout rate and the reasons that cause it. You can use this survey to monitor trends of students giving up high school and mitigate the reasons that cause them. Use this dropout prevention survey template to collect in-depth data and identify the factors that will help keep students in school.

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What is your gender?

Male

Female

Prefer not to say

What is your age?

13-14 years old

15-16 years old

17-18 years old

19 years and over

What is the highest grade level you have completed?

7th grade

8th grade

9th grade

10th grade

11th grade

Please specify your race

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

Other

Please specify your ethnicity

Hispanic or Latino

Not Hispanic or Latino

Please mention the reason that caused you to drop out of school:

Didn't like the school

Didn't like the staff

It was too far from home

My parents moved away

My parents got divorced so I had to move

I didn't find school helpful

I left to be homeschooled

My friends dropped out

I was bullied

I was sexually assaulted

I moved to a specialized high-school program

I joined a vocational program

I had to leave due to work

I had to leave due to sports

I had to leave due to arts

Please state your agreement with the following statements:

	Strongly disagree	Disagree	Neutral	Agree	Strongly agree
I would have stayed in school if I had support from my parents	Strongly disagree	Disagree	Neutral	Agree	Strongly agree

I would have stayed in school if I had support from my teachers	Strongly disagree	Disagree	Neutral	Agree	Strongly agree

The school management didn't pay heed to my concerns	Strongly disagree	Disagree	Neutral	Agree	Strongly agree

I was sexually assaulted on school premises	Strongly disagree	Disagree	Neutral	Agree	Strongly agree

I was bullied in and on the way to school	Strongly disagree	Disagree	Neutral	Agree	Strongly agree

If I moved closer to school, I wouldn't have to drop-out	Strongly disagree	Disagree	Neutral	Agree	Strongly agree

If the quality of education at this school was high, I would not have to leave to be homeschooled	Strongly disagree	Disagree	Neutral	Agree	Strongly agree

My friends left the school and I didn't want to stay back	Strongly disagree	Disagree	Neutral	Agree	Strongly agree

Alcohol and drugs caused me to dropout of school	Strongly disagree	Disagree	Neutral	Agree	Strongly agree

I wasn't counselled and didn't receive help at school	Strongly disagree	Disagree	Neutral	Agree	Strongly agree

	Strongly disagree	Disagree	Neutral	Agree	Strongly agree
I left due to peer pressure	Strongly disagree	Disagree	Neutral	Agree	Strongly agree

I got into petty thefts and crimes	Strongly disagree	Disagree	Neutral	Agree	Strongly agree

High school was way too difficult for me	Strongly disagree	Disagree	Neutral	Agree	Strongly agree

I left because I started working	Strongly disagree	Disagree	Neutral	Agree	Strongly agree

I had to work to support myself	Strongly disagree	Disagree	Neutral	Agree	Strongly agree

I had to work to support my family	Strongly disagree	Disagree	Neutral	Agree	Strongly agree

I didn't find high school to add value in my life	Strongly disagree	Disagree	Neutral	Agree	Strongly agree

I left school to concentrate on sports	Strongly disagree	Disagree	Neutral	Agree	Strongly agree

I left school to concentrate on arts	Strongly disagree	Disagree	Neutral	Agree	Strongly agree

I found homework and coursework to be very taxing	Strongly disagree	Disagree	Neutral	Agree	Strongly agree

What was the most difficult part of high school for you?

School work

Hours

Teachers

The school itself

Did you participate in any extra curricular activities or after school programs, clubs, etc?

Yes

No

What was your current GPA when you dropped out?

3.5 or higher

3.0 - 3.5

2.5-3.0

2.0-2.5

Less than 2.0

Not sure

What is the marital status of your parents/guardians?

Married

Divorced

Single

Widowed

Separated

If you were employed during high school, how many hours a week did you work?

Less then 10 hours

10-20 hours

20-30 hours

30 or more hours

I was not employed during high school

use this free template

Top Four reasons for using this free high school dropout survey questionnaire

Every year, 1.2 million high school students in the USA drop out of high school. That’s 7,000 students a day. Here are the main reasons why you must use this free survey template.
1. Explore the core reasons for dropout: Use this survey to get close to students and understand their plight and the main reasons why they drop out of school.
2. Improvements: There’s room for improvement in areas like bullying, course structure, fees, alcohol/drug use, school sexual abuse, to name a few. Find out the biggest hassles and take steps to improve processes to protect students.
3. Extracurricular activities: Often, extracurricular activities help keep the students in school. Find out what activities most students enjoy and keep these activities ongoing to help keep students from dropping out.
4. Find out what students find hard: Understand what is the most difficult part of high school for students and take steps to ease the hardship among students.

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