High School Dropout Questionnaire & Sample Survey Template

The high school dropout questionnaire is a survey that helps collect demographic information about students as well as understand the reasons for them to dropout of school. 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 dropout in high school children as well as mitigate the reasons that cause them. You can also use this survey template to collect in-depth data to identify the factors that will keep the students in school.

What is your gender?
What is your age?
What is the highest grade level you have completed?
Please specify your race
Please specify your ethnicity
Please mention the reason that caused you to drop out of school:
Please state your agreement with the following statements:
Strongly disagree
Strongly agree
I would have stayed in school if I had support from my parents
I would have stayed in school if I had support from my teachers
The school management didn't pay heed to my concerns
I was sexually assaulted on school premises
I was bullied in and on the way to school
If I moved closer to school, I wouldn't have to drop-out
If the quality of education at this school was high, I would not have to leave to be homeschooled
My friends left the school and I didn't want to stay back
Alcohol and drugs caused me to dropout of school
I wasn't counselled and didn't receive help at school
Strongly disagree
Strongly agree
I left due to peer pressure
I got into petty thefts and crimes
High school was way too difficult for me
I left because I started working
I had to work to support myself
I had to work to support my family
I didn't find high school to add value in my life
I left school to concentrate on sports
I left school to concentrate on arts
I found homework and coursework to be very taxing
What was the most difficult part of high school for you?
Did you participate in any extra curricular activities or after school programs, clubs, etc?
What was your current GPA when you dropped out?
What is the marital status of your parents/guardians?
If you were employed during high school, how many hours a week did you work?

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