Graduate Follow-up Form
First name
Last name
Date graduated
Address
City
State
Zip
Phone number
Email address
Who have you been spending time with this week?
What targets have you completed on your final discharge plan?
Do you have a job?
Yes
No
Details about the job or lack of job
How is it going with your family?
What condition are you in on the 1st dynamic? Please include details.
What condition are you in on your 2nd dynamic? Please include details.
What condition are you in on your 3rd dynamic? Please include details.
What condtion are you in on your 4th dynamic? Please include details.
Are you satisfied with the results of the Narconon® program? Please include details.
Do you have anything that you would like to add? If applicable, include any changes of address.