Please take a few moments of your time to complete & return this survey. Your feedback is necessary to help us in being more responsive to your particular needs and be a positive resource for our community. Thanks!
1. What is your relationship to Special Education?
b. School Administrator
e. Other __________________________
1b. Would you be interest in receiving certificates of attendance for workshops?
2. What is your special needs area of interest or concern? (i.e.: learning, physical, behavior, neurological, developmental, speech/language, autism, LD, etc.)
3. Do you consider yourself to be a member of the special education parent advisory council at this time?
4. If no, are you interested in becoming a member?
5. If you answered yes to either question, please provide the following information
Address ___________________________School ________________________
Phone # ___________________________E-mail _________________________
6. What grade-level is of concern to you?
Preschool Elementary Middle School High School
7. If you have not attended special education parent advisory council meetings/workshops, what were the obstacles?
a. Inconvenient day/time
b. Inconvenient location
c. Lack of transportation
d. Lack of childcare
e. Lack of time
f. Not interested
g. Other ____________________________________
8. How often would you prefer special education parent advisory council to meet?
____monthly ____bi-monthly ____quarterly
9. Volunteers are needed on the following committees. Please check any that interest you:
By-laws ____ Web site ____
Speakers/Workshops ____ Fundraising ____
Elections/Membership ____ School Committee Liaison ____
Scholarships/Awards ____ Library Project ____
Annual Review/3-Year Plan ____ Public Relations/Marketing ____
Quarterly Newsletter ____ Support Group/Database ____
Childcare ____ Refreshments/Hosting ____
School Liaisons____ (one for each school)
Disability Awareness_______ Inclusion _____________
10a. What topics are areas of interest to you and would motivate you to attend?
Identifying Special Needs ____ Basic Rights & The Laws ____
Early Intervention ____ Testing ____
IEP’s ____ Behavior Issues ____
Financial/Insurance ____ Environmental Adaptations ____
Sensory Processing/Integration ____ Communication Strategies ____
Speech & Language ____ Reading & Writing _____
Extracurricular/Summer Activities ____ Bus Driver Training _____
Homework ____ Family Issues ____
Inclusion ____ Mediation/Hearings ____
Other ________________________ Bullying and Teasing____
10b. Specific Disability Areas
ADD/ADHD ____ Autism/PDD ____
Downs Syndrome ____ Visual/Hearing Impaired ____
Developmental Disabilities ____ Physical Disabilities ____
Learning Disabilities____ Other ____________________
11. In what forum would you like to see these issues presented/addressed?
____ Outside GuestSpeakers ____ School Personnel/Parent Speakers
____ Workshops ____ Video Presentations
____ Support Group/adults ____ Networking with other SEPACs
____ School Programs for Students ____Support Group/students
____ Other _____________________________________________________
12. Provide any speakers or topics that may be of interest to others. Thank you!