Parent Survey Special Education Program Please help us evaluate our services. Complete and return to any building office secretary. Relationship to student:_________________________ Date:______________
My child is receiving the following services (check all that apply): __ 0-3 Homebased __ 3-5 Preschool Center Based __ Headstart
__ Resource Room __ Life Skills __ Speech __Occupational/Physical Therapy ================================================================== Circle Y for Yes or N for No 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. When your child was referred for special education services, did you receive a written copy of your rights (procedural safeguards)? Were your rights explained to you? If you had questions concerning your rights, were your questions answered fully? Did you receive a copy of your rights at the annual IEP and Reevaluation meeting? Were you invited to a meeting to discuss results of your child’s evaluation and eligibility? Did you receive a copy of the evaluation report? Have you been invited to your child’s IEP meetings? Does the district arrange other times if the scheduled IEP meetings are not convenient for you? Did you give input either before or during your child’s IEP meeting? Did you receive a copy of your child’s IEP? Y/N Y/N Y/N Y/N Y/N Y/N Y/N Y/N Y/N Y/N
Is your child receiving the services specified on his/her IEP? If no, please indicate what services your child is not receiving. Y/N ________________________________________________________ ________________________________________________________ Have you ever requested an IEP meeting? Was your request for an IEP meeting honored? Do you believe your child is making progress on his/her IEP goals? Y/N Y/N Y/N
12. 13. 14. 15. 16. 17.
Did you discuss Extended School Year (ESY) during the IEP process? If no, please explain:_______________________________________ Y / N ________________________________________________________ Have you ever requested a reevaluation? Y/N Was your request for a reevaluation honored? Y/N
Rev. 9/02
18.
Have you ever asked for an independent educational evaluation? If yes, please explain:____________________________________ ____________________________________________________ ____________________________________________________. Has your child been sent home, suspended, or denied services for more than ten days during the last school year? IF YES:
Y/N
19.
Y/N
20.
Did your child continue to receive special education services?
Y/N
As a parent I understand that this is an opportunity to give input into the district’s special education program. ================================================================== If you have a child who is 14 years or older, please answer the following questions. If your child is younger than 14, skip to the additional comments or suggestion Beginning at age 14, the district is required to begin developing a plan that will successfully transition your child from school to adult life. The purpose of transition planning is to focus attention on how the student’s educational program is planned and delivered to help the student make a successful transition to post-secondary education, adult service agencies, independent living skills, and/or employment. 21. 22 23. Has the district considered your child’s career interests and needs when developing the transition IEP? As a parent, have you participated in developing your child’s career interests and needs when developing the transition IEP? As a parent, have you participated in developing your child’s transition plan and IEP?
Y/N Y/N Y/N
24. Has your child been invited to transition and attended transition meetings? Y/N ================================================================== Additional comments or suggestions I would like to make are: _____________________ __________________________________________________________________ __________________________________________________________________ I have felt especially good about the following:________________________________ __________________________________________________________________ __________________________________________________________________ Thank you for helping to improve our special education services!
Rev. 9/02