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Form Hud-40201 - Youthbuild Program Reports - U.s. Department Of Housing And Urban Development Page 2

Section III: Exit Report

(Complete this Section only when a participant completes or leaves the program.)

20. Date of program exit:

21. Number of months in the Program:

22. Overall level of participation in the program:

a. High, participated in most functions

b. Medium, participated in some functions

c. Low, participated in few functions

23. Reason for Exit:

a. Successfully completed program

Reason left the program without completion:

b. Left Voluntarily

c. Asked to leave the program

d. Left because Essential Service was unavailable:(specify) ___________________________________________________________________

e. Other:(specify) _____________________________________________________________________________________________________

24. Highest Grade or Year of School completed when leaving program:

a. Less than 12

b. High School Graduate/GED

c. Trade School or Vocational School

d. Some College

25. Current Employment Status:

a. Employed, Full-time

b. Employed, Part-time

c. Unemployed

26. If employed, current hourly Wage Rate:

$ ______________

Number of hours, on average, working within a week:

_______________

27. If employed, list the broad industry occupational title:

a. Construction Laborer

b. Skilled Construction Trade

c. Construction Management

d. Property Maintenance

e. Other (specify actual job title): __________________________________________________________

28. If currently unemployed, the reason why:

a. Continuing Education

b. Entered Apprenticeship Program

c. Health

d. Family

e. Lack of Transportation

f. Other, specify: _______________________________________________________________________

Previous editions are obsolete

form HUD-40201 (7/97)

Form Hud-40201 - Youthbuild Program Reports - U.s. Department Of Housing And Urban Development Page 2