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Quick Links to Forms:

Employee Exit/Transfer Interview Form

Date:
Name: (optional):
1. Would you like your answers to be kept confidential to the extent permitted by law?
	Yes No, you may share them with department/unit heads
2. Period of Employment
	years
3. I am:
	Retiring Leaving UW Oshkosh Transferring to another unit/department
4. Employment category (check as many as are applicable):
	Instructional Academic Staff Non-instructional Academic Staff Lecturer Assistant Professor Associate Professor Full Professor Classified Staff - permanent position LTE Classified Staff	Fixed-term appointment Limited appointment Part-time Full-time Tenured Non-tenured Project Appointment Classified Staff Other (please describe):
5. Name of department/unit (optional):
6. Your age:
	20-29 30-39 40-49 50-59 60-69 70+
7. Your Gender:
	Female Male
8. Racial/Ethnic group with which you identify:
	American Indian/Alaska Native Asian Black/African American Hispanic or Latino Native Hawaiian/Other Pacific Islander White Other:
9. Do you have a disability?
	Yes No
10. Which of the following factors first caused you to look for another position or consider retirement (check as many as are applicable):
	Health Reasons Better geographic location Relocation of spouse/partner Pursued by another employer Better salary elsewhere Family/personal matters Career advancement Further education or training Issues related to students Inadequate research facilities and support	Inadequate professional development opportunities/budget Lack of congeniality in the community Lack of congeniality in the department/unit Lack of congeniality in the University Non-supportive environment Dissatisfaction with department/unit administration Appointment not renewed Dissatisfaction with governance Other
11. Please elaborate on any of the factors checked in # 10 above.

12. Remembering back to when you first were offered this position, what most attracted you about working at UW Oshkosh?

13. If you were a member of the administration and things were implemented as you believed they should, what would the workplace environment look like?

14. What advice would you give to the person replacing you?

15. How do the opportunities offered at UW Oshkosh provide impetus for personal and professional growth?

16. UW Oshkosh's mission is to honor and respect diversity. Do you feel this was reflected in your experience here?

17. What would have persuaded you to stay in this position?

18. When you reflect on your time with UW Oshkosh, what are your distinctive memories?

Questions? Contact Jan Keene keene@uwosh.edu

Office of Equity & Affirmative Action
Dempsey 211
424-2296

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