Intended Destinations Survey

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							Intended Destinations Survey
Section A: About you and your school
  1.       What is your full name



  2.       What is your date of birth (Please give date, month and year, eg, 01/01/1990)



  3.       What is your address




                                                          Postcode


  4.       What is your home telephone number



  5.       What is your mobile telephone number



  6.       What is your e-mail address



  7.       Which district do you go to school in



  8.       And what is the name of your school



  9.       What is your ethnicity

       White British                      White Irish                          White Other

       Mixed White & Black Caribbean      Mixed White & Black African          Mixed White & Asian

       Mixed Other                        Chinese                              Black or Black British Caribbean

       Black or Black British African     Black or Black British Other         Asian or Asian British Indian

       Asian or Asian British Pakistani   Asian or Asian British Bangladeshi   Asian or Asian British Other
Section B: About your plans
  10.   Do you have a clear idea of what you would like to do after finishing year 11?

        Yes                                           No

  11.   If you have no definite plans, would you like to see a Connexions Personal Adviser?

        Yes                                           No

  12.   What do you intend to do after finishing year 11? Please mark your 1st preferred choice, and
        your 2nd choice from the following six choices (marking 1st and 2nd in the boxes below). You
        will be given an opportunity to explain your choice after.

        Stay on at the school you currently attend (if it has a sixth form)

        Got to another school sixth form

        Go to College

        Take up an Apprenticeship

        Find a job

        Other

  13.   Please give details of your choice(s), eg, what school/course you would like to do, what
        job/apprenticeships you are interested in




Section C: About your activities

  14.   In the last 4 weeks have you taken part in any activity led by an adult outside school lessons,
        eg, sports, arts or a youth group?

        Yes                                           No

  15.   Which of these have you participated in?

        Sports club or class where I have done sport, not just watched it

        A youth club or youth group with organised activities run by adults

        Art, craft, dance, drama film/video making group or class (not in school)

        Music group or lesson (not within school lessons)
Section D: Information sharing


In order to help with future planning about Post 16 courses and employment
opportunities, it would be helpful if your school has a better understanding of your Post 16
education or employment experiences. This information would help inform your school's
planning about curriculum and pastoral support in the future.

This information will only include your name and details of where you are learning / what
courses you have followed and whether you are still involved in learning/employment with
training.

I agree that information about my post 16 education/employment experience can be shared with
my school once I have left. The school will keep this information confidential and it will only be
used for the purposes of planning future services. The information will not be shared with any
other third parties without my consent.

*If you change your mind and decide to withdraw consent, please contact Connexions and inform
them of this

Yes, I agree that my details can be shared with my school once I have left

No, I do not agree that my details can be shared with my school once I have left




                                 Thank you for completing this form

    Essex County Council is registered under the Data Protection Act 1998. Any personal
     information which you give us will only be used for the purpose of providing you with
                                    Connexions services.



                         Connexions KIC Team, Essex County Council

                  Suite 5, Warren House, 10-20 Main Road, Hockley, SS5 4QS

                                          Tel: 01702 208850

                                   www.essexconnexions.co.uk

						
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