Grambling State University

Program Evaluation Demographic Form

Mark the box that applies
Age:
20 to 25 26 to 30 31 to 35 36 to 40 41 to 45	46 to 50 51 to 55 56 to 60 Greater than 60

Gender: M F

Race/Ethnicity: Caucasian African-American Hispanic, Native American Other

Income: (This is just your income. Not your household income)
0 to 10,000 10,001 to 15,000 15,001 to 20,000 20,001 to 25,000 25,001 to 30,000 30,001 to 40,000 40,001 to 50,000	50,001 to 60,000 60,001 to 70,000 70,001 to 80,000 80,001 to 90,000 90,001 to 100,000 Greater than 100,000

Have you already accepted an invitation to work at a healthcare facility upon graduation? Yes No

If so, which facility and where?

Are you planning to practice nursing in another state? Yes No

If so, where are you planning to move?

Have you thought about pursuing further education? Yes No

What do you plan on pursuing?
Nurse Practitioner Nurse Anesthetist Wound Care Specialist	Nurse Educator Nurse Administrator

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