Parent Support Group Parent Survey

Parent Advisory
Families with Disabilities
Parent Survey

Please respond to the following statements. Select the option that most accurately reflects your experience with your child's education programs(s). Please answer all questions. Thank you!

*	Required
1.	* Name:
2.	* E-Mail Address:
3.	* Child's School:
4.	Child's Grade Level If you have more than one child receiving services, fill out the survey and answer the questions with only one child in mind. Please select the grade level of your child below:
	Preschool Elementary Jr. High Senior High
5.	Please check the box below that describes your child's educational programs/services.
	a. Early Childhood Program (prior to 5 years old) b. Special Education at Neighborhood School c. Special Education/Self Contained Program d. Special Education & Therapy e. Therapy Only (Occupational, Speech, etc.) f. English Language Learner (ELL) g. TitleI/LAP (Assistance in reading/math) h. Unsure
6.	Please select the answer that best describes your opinion to the following statements.
	The people who work with my child are open and communicate a caring attitude toward my child and family. I have had the opportunity to become actively involved in my child's program. I have had the opportunity to give my input in my child's program. When I've had a concern about my child's program, the school staff has been understanding and responds in a timely manner. I am informed on my child's progress, services, and activities. Overall, the program(s) and services are appropriate for my child's needs. Please include additional comments or suggestions below:

7.	What do you see as a strength of your child's program?
8.	What will improve your child's program?
9.	What is the greatest challenge to you as a parent/guardian of a special education student?
10.	What are some topics you may be interested in learning more about? Please check all that apply below:
	a. Understanding Your Child's IEP b. District Special Education Services & Options c. Behavioral Issues d. Legislative Issues e. Community and School Resources f. State Service Agencies g. ADD/ADHD h. Inclusion i. Communication: School & Family j. Transition Planning k. Autism/Asbergers l. Parents Rights & Responsibilities m. Learning Disabilities n. Recreation Opportunities o. Physical Therapy p. Speech q. Occupational Therapy r. Other (Please explain below)

11.	* Would you need childcare in order to attend the meetings?
	Yes No
12.	What are good times for you to attend the meetings? a. 6:00 PM b. 6:30 PM c. 7:00 PM Other - Please explain below:
13.	How often would you like to see the meeting occur? Please check all that apply: a. Monthly b. Every two months c. Quarterly
14.	* Are you interested in being a core team member of the Advisory Committee?
	Yes No
	If yes, please provide your name(s) and phone number(s) below:
15.	* Please enter today's date in the following format: MM-DD-YY (Example: 11-12-07 * Note: must contain hyphens)

Parent Support Group Parent Survey

If you prefer, you may download and fill out the survey at: Parent Survey. You will need the Adobe Acrobat Reader to download this document. If you do not have this program, you may download it for free at: Adobe Acrobat Reader

Please mail the completed survey to:

Parent Advisory
c/o Parent Support Group
27315 152nd Ave E
Graham, WA 98338


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