CAMPUS & STUDENT INFORMATION:

Graduate Name:

Email Address:   Phone Number:  

Gender: MaleFemale  Ethnicity: WhiteNative Hawaiian or Other Pacific IslanderHispanic or LatinoBlack or African AmericanAsianAmerican Indian or Alaska NativePrefer Not to Say 

Program: Dental AssistantClinical Medical AssistantMedical Administrative Assistant (MAA)MAA with Electronic Health RecordsMAA with Billing & CodingMAA with Electronic Health Records and Billing & CodingMAA with Project ManagementMAA with Social Media Strategist MAA with Human ResourcesMAA with Bookkeeping and PayrollBusiness AdministrationPharmacy TechnicianPhlebotomy TechnicianElectronic Health RecordsMedical Billing & Coding 

Start Date

Graduation Date

Instructor(s):  

PAYMENT INFORMATION:

Method of Payment: CashCredit CardCheckVive FinancingParamount FinancingClimb FinancingIHFPath 2 PromiseUnited WayMoney OrderWIOACareer SourceCampbell StrongMYCAAMeritize 

PLACEMENT CONFORMATION:

Place of Employment:  

Name of Employer/Contact Person:  

Business Street Address:  

City:    State: StateAlabamaAlaska ArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisiana MaineMarylandMassachusettsMichiganMinnesotaMississippiMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth Carolina North DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashington West VirginiaWisconsin Wyoming   Zip Code:  

Business Phone Number:   Business Fax Number:  

Business E-Mail:  

Date of Employment:

Job Title:  

Please List Four Job Duties:

Job Duty #1:  

Job Duty #2:  

Job Duty #3:  

Job Duty #4:  

Wage Per Hour:    Total Hours per Pay Period:  

Does the Student Need Placement Assistance? YesNo 

GRADUATE SURVEY:

Please respond to the following:
INSTRUCTIONS: Consider each item separately and rate each item independently of all others. Select the rating from the dropdown that indicates the extent to which you agree with each statement. Please do not skip any item. Any question scored less than 3 requires explanation or if you wish to leave additional comments, please describe in the box below the statement. All graduates must complete this survey to receive their transcript and certificates.

5 = Strongly Agree 4 = Agree 3 = Acceptable 2 = Disagree 1 = Strongly Disagree

General Evaluation

I was informed that I would receive a program certificate of completion after completing all requirements. 12345 

The program adequately prepared me for employment. 12345 

The clinical externship portion of the program adequately prepared me for employment, if applicable. 12345 

Upon completion of my classroom training, an externship site was available to me, if applicable. 12345 

Admissions staff are knowledgeable in programs and provide courteous service. 12345 

The course content is consistent with the program’s goals. 12345 

I would recommend this program/institution to friends or family members. 12345 

Instructor Evaluation

My instructors were knowledgeable in the subject matter and relayed this knowledge to the class. 12345 

The instructor’s development and presentation of material is consistent with the syllabus. 12345 

The instructor explains concepts clearly and in an organized manner. 12345 

The instructor encourages group interaction and critical thinking. 12345 

The instructor provided adequate feedback in a timely manner. 12345 

I, , acknowledge upon MedCertify receiving this Graduate Survey my Transcript(s) and Certification(s) will be delivered to me. I acknowledge I have had the opportunity to express my thoughts in writing concerning my education with MedCertify. I also authorize and give consent to MedCertify to contact my employer for employment verification information needed for state licensure compliance as well as federal and authorized workforce agencies for career placement records. 

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Document name: Exit Interview

Unique Document ID: 0dfa396f4efad9e2f4bb7f1d2139b9e9bd4cc4e4

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Timestamp	Audit
February 8, 2022 3:49 PM EDT	Exit Interview Uploaded by MedCertify Education - [email protected] IP 99.190.9.234
February 15, 2022 2:01 PM EDT	MedCertify Edu - [email protected] added by MedCertify Education - [email protected] as a CC'd Recipient Ip: 99.190.9.234
August 25, 2022 9:54 AM EDT	MedCertify Edu - [email protected] added by MedCertify Education - [email protected] as a CC'd Recipient Ip: 99.190.9.234
September 23, 2022 10:48 AM EDT	MedCertify Edu - [email protected] added by MedCertify Education - [email protected] as a CC'd Recipient Ip: 35.134.226.248
October 27, 2022 10:24 AM EDT	MedCertify Edu - [email protected] added by MedCertify Education - [email protected] as a CC'd Recipient Ip: 99.190.9.234

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