Student Questionnaire

South Bend Community School Corporation

Special Education Services

215 S. St. Joseph St, South Bend, IN 46601

Ph: 574.283.8130 Fax: 574.283.8105

Please complete this questionnaire and bring it to the Annual Case Conference for this student.

Student Name: __________________________ STN#: ______________________ Date: ___________________

Recorded by (if other than student: _______________________School: __________________ Grade: _________

Are your classes/special services helpful to you? What other help do you need?

What accommodations/modifications work best for you?

What are your strengths and weaknesses?

What are your interests/academic and extracurricular?

What are your goals for your future?

8/19/12

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Parent category: Life