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)