Please fill out the form below, once completed press the submit button at the bottom of the page.
Work Experience Student Survey
Leicester / shire Work Experience Alliance (WEXA) works with schools in Leicester / shire supporting work experience. We strive to provide a quality service at all times and value direct feedback from our clients. We would appreciate you taking a few moments to answer the following questions regarding your recent experience. Please be assured that individual information will remain confidential.
Placement Organisation/Business Name.	A value is required.
Placement Type - please select from the following categories to choose placement type	Please Select... Administration Building and Construction Maintenance Manufacturing Service Industries Sport and Leisure Please select an item.Select the placement type category..... Waiting on Main Selection Please select an item.Now choose placement type from this list
Placement Date Start	A value is required.Invalid format. Click calendar to choose start date Format required Year/Month/Day i.e 2008/08/27
Placement Date End	A value is required.Invalid format. Click calendar to choose end date Format required Year/Month/Day i.e 2008/08/27
Your School/College.	Ash Field School Ashby School Ashmount School Babington Community College Beauchamp College Beaumont Leys Specialist Science School Birch Wood Birkett House School Bosworth Community College Brooke House VIth Form College Brooksby Melton College Burleigh College Children's Hospital School Countesthorpe College Crown Hills School De Lisle Catholic Science School Dorothy Goodman School Ellesmere College English Martyrs R.C. School Forest Way Fullhurst Community College Gateway 6th Form Groby College Guthlaxton College Hamilton Community College Hind Leys Community College John Cleveland College Judgemeadow School Keyham Lodge School King Edward VII, Coalville King Edward VII, Melton Lancaster School Leicester College Longslade College Loughborough F.E. College Lutterworth College Madani High School Maplewell Hall School Millgate Centre Moat Community College N. Warwickshire & Hinckley College Nether Hall School New College Rawlins Community College Regent College Riverside Business and Enterprise College Rushey Mead School Sir Jonathan North Community College Soar Valley Community College South Leicestershire College St. Pauls R.C. School Stephenson College The City of Leicester College The Grange School The Mount School The Robert Smyth School West Gate School William Bradford College Wreake Valley College Wyggeston QE1 ZZ Other Please select an item.Select your school/college
Your Gender	Female Male Please select an item.
This completes the details about your placement. Page 2 of this form asks for your opinion on your Work Experience Placement

If you do not move on to the multiple choice question page please check above that you have filled in all the required elements.