Member Status Change Form

This form is to be filled out and submitted once a member has a new job or is leaving the organization. This form is continually being reviewed and revised to meet the needs of the members and organization.

Member Information
Worknet ID:
Which Committee:
Email (required)
First name(required)
Last name(required)
Phone #
Did you move?  No Yes
Address
City
State
ZIP
Reason for Leaving
Reason for Leaving:
Details:
Employment Information
Employer Name Business Type
Employer City Employer State
New Position Start Date
Previous Industry New Industry
Responsibility
Salary
Job lead source:
Details:
Exit Interview
As an Alumni, would you like to be contacted with PRN updates?  Yes No
Would you be available for PRN members to network with you or obtain information about your career or company?  Yes No
Satisfaction Survey
In a sincere effort to better understand how PRN can improve the satisfaction of its members, we are asking for your help. Please candidly answer the questions below and feel free to add any additional comments in the space provided. Your valuable time and honesty are much appreciated.
Facilitators
The following questions relate to Co-Chairs, Front Desk staff and Half-Day Managers.
Conducted self in a professional manner:  Strongly agree Agree Neutral Disagree Strongly disagree
Answered your questions in a professional and satisfactory manner:  Strongly agree Agree Neutral Disagree Strongly disagree
Was helpful through the orientation process:  Strongly agree Agree Neutral Disagree Strongly disagree
The overall management would be better if:
Business Resource Center
The following questions relate to your opinion of the PRN Center.
PRN members were professional, knowledgeable and helpful:  Strongly agree Agree Neutral Disagree Strongly disagree
Workshops & Guests Speakers were beneficial:  Strongly agree Agree Neutral Disagree Strongly disagree
Use of computers/internet, fax, telephones & copiers helpful:  Strongly agree Agree Neutral Disagree Strongly disagree
The hours of operation of the center were convenient:  Strongly agree Agree Neutral Disagree Strongly disagree
Your overall experience with the PRN center was excellent:  Strongly agree Agree Neutral Disagree Strongly disagree
The PRN center experience could be improved by:
Conclusions/Comments
Would you recommend PRN to a friend?  Yes No
Did PRN fulfill your expectations?  Yes No
Would you use PRN again?  Yes No
Comments regarding the PRN experience:
What about the PRN experience that had the best results for you?

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