CLIP Survey

We need your help! Mesa Community College, City of Mesa, and Mesa Public Schools want to double the number of low-income young adults (ages 16-26) who complete a college certificate or degree with value in the marketplace.

Please take a moment and help us identify barriers that may prevent low-income young adults from completing college and achieving a successful career and actions that need to be taken to minimize or remove these barriers.

Barriers can be challenges faced by an individual or policies and procedures that make it difficult to achieve success. These barriers may occur before students get to college, as they are transitioning to college, while in college, or when trying to transition to the workforce. Please identify barriers that may prevent low-income young adults from completing college and achieving a successful career (an example includes, but is not limited to, being unable to afford tuition):

2.	Please identify actions that need to be taken in order to minimize or remove the barriers identified above:

Please tell us about yourself:

Age:

4.	Gender: Female Male

5.	Ethnicity: American Indian/Alaskan Native Asian or Pacific Islander Black, not of Hispanic origin Hispanic White, not of Hispanic origin Other:

6.	Education: Some high school High school diploma GED Professional certification Associate degree Bachelor degree Master degree Doctoral degree Professional degree (JD, PSYD) Other:

7.	Annual Household Income: Less than $10,000 $10,000 - $29,999 $30,000 - $49,999 $50,000 - $69,999 $70,000 - $89,999 $90,000 – $109,999 $110,000 – $149,000 $150,000 or more

8.	Which of the following best describes you? Parent Student Social Service Employee Mesa Public Schools Employee Mesa Public Schools Faculty MCC Employee MCC Faculty City of Mesa Employee Business/Industry/Employer Other:

Name:

First	M.I.	Last

Email: