Parent Survey Form
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1PARENT SURVEY
In an attempt to continually improve Special Education programs, processes, and services, we request your input in evaluating current services and identifying
areas that may need improvement. Please take a few minutes to complete this survey by providing your response to each item. Your input is greatly
appreciated. Please return this survey to_________________________________________ by _____________________.
Name
Date
1.
Please check any school activities you participated in during the past school:
____Parent Conferences
____IEP Team Meetings
____Eligibility Committee Meetings
____Student Assistance Team Meeting
____School Volunteer
____LSIC
____PTO/PTA
____Other _____________________________________
2.
Have you participated in training offered by: (please check all that apply)
____Parent Educator Resource Center (PERC)
____Your Child’s School
Was this training of benefit to your child/family?
____Yes ____No
Please list topics of parent training that would be helpful for you. (Please use the back of this sheet to list your requests.)
3.
During the past school year, how did you and the school communicate about your child? (Please check all that apply)
____Telephone Calls
____ Written Notes/Letters
____Home/school Visits
____Regular Progress Reports
____Notebooks/organizers sent between home/school
____IEP Team Meeting Notices
____Eligibility Committee Meeting Notice
____Procedural Safeguards Notice (pamphlet about rights)
____ E-mail/Web Site
____Other ___________________________
4.
If your child was evaluated or reevaluated, did you provide information to the evaluators (parent report)?
____Yes ____No
5.
If you attended the IEP Team meeting, did you actively participate in discussing your child’s IEP needs?
____Yes ____No
6.
Do you use information from working with your child in the development of your child’s IEP?
____Yes ____No
7.
Does the IEP team use this information in the development of your child’s IEP?
____Yes ____No
8.
How often do you help your child with homework related to the IEP objectives? _____ (hours per week)
9.
Has your child been invited to participate in tutoring programs before school, after school or on faculty senate days? ____Yes ____No
10.
Does your child participate in school sponsored extra-curricular activities?____Yes ____No If no, explain ______________________________
11.
If your child has been disciplined in any of the following ways this year, please indicate the number of days:
_____ In-School Suspension
____ Out of School Suspension
_____ Expulsion
____ Bus Suspension
As part of the discipline process, did the following take place:
___ the IEP was reviewed/revised to address behavior
(Please check all that apply)
___ behavior intervention plan was developed or revised
___ functional behavior assessment was conducted/reviewed
12.
Please indicate your level of satisfaction with the following special education programs and services by placing a checkmark in the appropriate
column.
Process/Service
Very Satisfied
Satisfied
Somewhat
Dissatisfied
Uncertain or Not
Applicable
Dissatisfied
Student Assistance Team
Screening/Identification/Referral
Evaluation/Re-Evaluation
Eligibility Determination
IEP Development/Placement
IEP Implementation
Related Services
Occupational therapy,
physical therapy, speech,
orientation/mobility
Transition Planning/Services
Extended School Year Eligibility/Services
Transportation
Overall Satisfaction
Thank you for your input. If you have a concern and wish to be contacted, please complete the following:
Child’s Name:
School ____________________Parent’s Signature:
Phone:
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