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
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?
11. If you have no definite plans, would you like to see a Connexions Personal Adviser?
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
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?
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
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 KIC Team, Essex County Council
Suite 5, Warren House, 10-20 Main Road, Hockley, SS5 4QS
Tel: 01702 208850