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by
Lesley Tomaszewski, Don Seaman, Chia-Yin Chen, and Elaine Demps
APPENDIX E
ADULT LEARNER STUDENT SURVEY
Student Survey
Focus Group: _____________________________ Date: ____________
Alias: ____________________________________________________
Native language: ______________________ Length of time in the U.S.: _____
Completed up to ___________________ grade level.
Lives in _____________________________ (city)
| Age | Ethnicity |
Occupation: ____________________________________
Employer: _______________________________________________
Works:
Number of adult (s) at home: ____________________________
Annual Family Income
Number of child (ren) at home: ______________________
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