BiTmaP Program Career Development Matching and Reporting Survey (Designed to capture data needed to justify Matching, and base DOL quarterly reporting upon.)

Student Name:
		Last	First

Current Employment Data

Employment Status: (Check all that apply.)

Employed:     Under-Employed:     Unemployed: Full-Time:     Part-Time:

Employer:
Location:
Job Title:
Employment Start Date:				Starting Salary:
Total Salary Increase:				Hours Per Week:

If you had a different employer when you started the BiTmaP Program please provide the following information (or check "Same As Above").

Same As Above (Check if applicable, then skip to next section.)

Employment Status: (Check all that apply.)

Employed:     Under-Employed:     Unemployed: Full-Time:     Part-Time:

Employer:
Location:
Job Title:
Employment Start Date:				Starting Salary:
Total Salary Increase:				Hours Per Week:

Internship Data

Employer:
Location:
Internship Title:
Internship Start Date:				Ending Date:
Internship Status:		Paid:     Unpaid:		Stipend/Salary:
Hours Per Week:				Subsequent Job:    Yes: No:

Mentorship Data

Mentor:
Mentorship Start Date:				Ending Date:
Hours Per Week:				Subsequent Job:    Yes: No:

BiTmaP Participant Career Objectives and Comments

Seeking:   (Check all that apply.)

Employment:		Full-Time:     Part-Time:     Permanent:     Temporary:
Internship:		Unpaid:     Paid:
Mentorship:		Yes:

Your comments about the BiTmaP Program or anything additional: