CAMPUS & STUDENT INFORMATION:

Campus LocationBowling Green Campus 944 Fields Dr. Suite 103 Bowling Green, KY 42104Elizabethtown Campus 101 Magnet Drive, Suite 120 Elizabethtown, KY 42701Florence Campus 6900 Houston Rd. Building 600 Ste 24 Florence, KY 41042Hopkinsville Campus 130 Hammond Drive Hopkinsville, KY 42240Lexington Campus 2720 Old Rosebud Rd. #230 Lexington, KY 40509London Campus 41 Old Pond Rd. London, KY 40741Owensboro Campus 3333 Frederica St. Ste 1 Owensboro, KY 42301Somerset Campus 246 Poplar Ave, Ste 2 Somerset, KY 42502Online 2720 Old Rosebud Rd. #230 Lexington, KY 40509

Graduate Name:

Graduate Street Address:   City:  

State: AlabamaAlaska ArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisiana MaineMarylandMassachusettsMichiganMinnesotaMississippiMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth Carolina North DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashington West VirginiaWisconsin Wyoming Zip Code:  

Email Address:   Phone Number:  

Gender: MaleFemale  Ethnicity: WhiteNative Hawaiian or Other Pacific IslanderHispanic or LatinoBlack or African AmericanAsianAmerican Indian or Alaska NativePrefer Not to Say 

Program: Dental AssistantClinical Medical AssistantMedical Administrative Assistant (MAA)MAA with Electronic Health RecordsMAA with Billing & CodingMAA with Electronic Health Records and Billing & CodingMAA with Project ManagementMAA with Social Media Strategist MAA with Human ResourcesMAA with Bookkeeping and PayrollBusiness AdministrationPharmacy TechnicianPhlebotomy TechnicianElectronic Health RecordsMedical Billing & Coding 

Start Date

Graduation Date

Instructor(s):  

PAYMENT INFORMATION:

Method of Payment: CashCredit CardCheckVive FinancingParamount FinancingClimb FinancingIHFPath 2 PromiseUnited WayMoney OrderWIOACareer SourceCampbell StrongMYCAAMeritizeMiaShareTradeupLeifAscent 

PLACEMENT CONFIRMATION:

Please put any type of Employment, whether in-field or out-of-field. If not employed, please put "Not Employed" in Required Boxes.

Place of Employment:  

Name of Employer/Contact Person:  

Business Street Address:  

City:    State: StateAlabamaAlaska ArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisiana MaineMarylandMassachusettsMichiganMinnesotaMississippiMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth Carolina North DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashington West VirginiaWisconsin Wyoming   Zip Code:  

Business Phone Number:   Business Fax Number:  

Business E-Mail:  

Date of Employment:

Job Title:  

Please List Four Job Duties:

Job Duty #1:  

Job Duty #2:  

Job Duty #3:  

Job Duty #4:  

Wage Per Hour:    Total Hours per Week:  

Does the Student Need Placement Assistance? YesNo 

GRADUATE SURVEY:

Please respond to the following:
INSTRUCTIONS: Consider each item separately and rate each item independently of all others. Select the rating from the dropdown that indicates the extent to which you agree with each statement. Please do not skip any item. Any question scored less than 3 requires explanation or if you wish to leave additional comments, please describe in the box below the statement. All graduates must complete this survey to receive their transcript and certificates.

5 = Strongly Agree 4 = Agree 3 = Acceptable 2 = Disagree 1 = Strongly Disagree

General Evaluation

I was informed that I would receive a program certificate of completion after completing all requirements. 12345 

The classroom/clinical portion of the program adequately prepared me for employment. 12345 

The clinical externship portion of the program adequately prepared me for employment, if applicable. 12345 

Upon completion of my classroom training, an externship site was available to me, if applicable. 12345 

Admissions staff are knowledgeable in programs and provide courteous service. 12345 

The course content is consistent with the program’s goals. 12345 

I would recommend this program/institution to friends or family members. 12345 

Instructor Evaluation

My instructors were knowledgeable in the subject matter and relayed this knowledge to the class. 12345 

The instructor’s development and presentation of material is consistent with the syllabus. 12345 

The instructor explains concepts clearly and in an organized manner. 12345 

The instructor encourages group interaction and critical thinking (if applicable). 12345 

The instructor provided adequate feedback in a timely manner. 12345 

STUDENT SERVICE LINKS

I, , acknowledge upon TMIKY, IDT and Choice MD receiving this Graduate Survey my Transcript(s) and Certification(s) will be delivered to me. I acknowledge I have had the opportunity to express my thoughts in writing concerning my education with TMIKY. I also authorize and give consent to TMIKY, IDT and Choice MD to contact my employer and obtain employment verification needed to maintain licensure requirements and placement tracking records. 

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Document name: Exit Interview

Unique Document ID: aec0f5393eed9ebea929165726a6fc3e20c56324

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Timestamp	Audit
August 19, 2022 2:14 pm GMT	Exit Interview Uploaded by Greg Goins - [email protected] IP 99.190.9.234
August 19, 2022 2:15 pm GMT	Enrollment Agreements - [email protected] added by Greg Goins - [email protected] as a CC'd Recipient Ip: 99.190.9.234

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