High School - East Jackson Special Education Resources



East Jackson High School

Transition Survey

Name: _________________D.O.B:____________ School: __________________ Date:________

1. After you finish high school, what kind of work do you want to have?

________________________________________________________________________________

| |9th |10th |11th |12th |

|Personal Management | | | | |

|1. I have a copy of a certified birth |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|certificate | | | | |

|2. I have a social security card and |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|know my number | | | | |

|3. I have a picture Michigan ID |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|4. I have a Driver’s License |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|5. I have public or family assistance |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|for transportation | | | | |

| | | | | |

|Personal Power |9th |10th |11th |12th |

|6. I feel good about myself and have |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|good self-esteem | | | | |

|7. I feel good about my appearance |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|and the way I look | | | | |

|8. My personality is usually upbeat |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|and positive | | | | |

|9. Most of my decisions are good for |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|others and myself | | | | |

| | | | | |

|Career Goal |9th |10th |11th |12th |

|10. I know what job or career I want |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|for the future | | | | |

|11. I know the employment trends for |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|my career choice | | | | |

|12. I know what training I need for my |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|career | | | | |

|13. I know where to find the training I |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|need for my career | | | | |

| | | | | |

|Plans |9th |10th |11th |12th |

|14. I plan to get an after school job |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|15. I plan to attend the JACC(Jackson Area Career Center) |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|16. I have a resume |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|Plans |9th |10th |11th |12th |

|17. I plan to do (WSBL) Work-Site |□ Yes □No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|Based Learning | | | | |

| | | | | |

|Accommodations |9th |10th |11th |12th |

|18. I know what job accommodations I |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|may need | | | | |

|19. I know where and how to ask for |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|accommodations | | | | |

|20. I am enrolled with M.R.S. |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|(Michigan Rehabilitation Services) | | | | |

| | | | | |

|Getting A Job |9th |10th |11th |12th |

|21. I know how to build a network of |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|contacts for job leads | | | | |

|22. I know how to interview people |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|about job leads | | | | |

|23. I can perform with confidence in a |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|job interview | | | | |

|24. I can complete a high quality job |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|application | | | | |

| | | | | |

|Succeeding on the Job |9th |10th |11th |12th |

|25. I can work independently |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|on the job | | | | |

|26. I can accept criticism from |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|supervisors | | | | |

|27. I can get along well with a boss & |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|co-workers | | | | |

|28. I will be on time for work |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|After High School, what additional education or training do you want to pursue? |

|________________________________________________________________________________ |

|Life-Long Learning |9th |10th |11th |12th |

|29. I feel positive about what I’ve |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|learned in school | | | | |

|30. I would like to have more |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|education in the future | | | | |

|31. I can locate and use the library |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|32. I am ready to learn new job skills |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|for my career | | | | |

| | | | | |

|Self-Advocacy |9th |10th |11th |12th |

|33. I feel positive about my decisions |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|and myself | | | | |

|Self-Advocacy |9th |10th |11th |12th |

|34. I feel confident about standing up |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|for my beliefs | | | | |

|35. I can contact the appropriate |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|resources for assistance | | | | |

|36. I can handle myself with |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|confidence in a meeting | | | | |

| | | | | |

|Education Options |9th |10th |11th |12th |

|37. I know about cost and entrance | | | | |

|requirements for the following | | | | |

|38. Jr. College |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|39. 4 Year College |□ Yes □ |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|40. Trade School |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|As an Adult, what hobbies and activities do you want to have? |

|______________________________________________________________________________ |

|Communication |9th |10th |11th |12th |

|41. When I talk to myself, I usually |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|say positive things | | | | |

|42. When I talk to my friends, I am |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|usually positive | | | | |

|43. When I talk to my family I am |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|usually positive | | | | |

|44. When I talk to adults, I am |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|respectful and positive | | | | |

| | | | | |

|Community Participation |9th |10th |11th |12th |

|45. I respect and obey the laws |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|46. I know how to use transportation |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|in my community | | | | |

|47. I am willing to volunteer in my |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|community | | | | |

|48. I conserve natural resources in |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|my community | | | | |

| | | | | |

|Leisure Time |9th |10th |11th |12th |

|49. I take time for fun activities in my |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|free time | | | | |

|50. I try to learn a new skill in my |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|leisure time | | | | |

|51. I take time to relax and rest my |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|mind and body | | | | |

|52. I participate in a physical activity |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|or sport | | | | |

|As an adult, where do you want to live? |

|____________________________________________________________________________ |

|Consumer Skills |9th |10th |11th |12th |

|53. I know the difference between my |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|wants and needs | | | | |

|54. I can maintain and balance a |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|checking account | | | | |

|55. I can use a credit card wisely |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|56. I can keep a household budget |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|and pay bills on time | | | | |

| | | | | |

|Personal Health |9th |10th |11th |12th |

|57. I can name my doctor and dentist |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|58. I know how to store and take |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|medicine safely | | | | |

|59. I eat right and exercise regularly |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

| | | | | |

|Living Independently |9th |10th |11th |12th |

|60. I can find a place to live and set |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|up utilities | | | | |

|61. I can plan and cook simple meals |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|62. I can wash, dry, and iron clothes |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|63. I can clean up an apartment or |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|house | | | | |

| | | | | |

|Family Living |9th |10th |11th |12th |

|64. I know what to look for in a |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|marriage partner | | | | |

|65. I can negotiate with someone so |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|both of us win | | | | |

|66. I know the value of support |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|people in my life | | | | |

|67. I know the basics quality |□ Yes □ No |□ Yes □ No |□ Yes □ No |□ Yes □ No |

|parenting | | | | |

9th Grade

Starting with the first page, circle all of the “no” answers on each page. Review all of your “no” answers, and choose the five most important. Write these below, naming the topic area and the specific item you will work on.

1. Topic: _____________________________________________________________________

Specific Item: ___________________________________________________________________________

2. Topic: _____________________________________________________________________

Specific Item: ___________________________________________________________________________

3. Topic: ______________________________________________________________________

Specific Item:

___________________________________________________________________________

4. Topic: _____________________________________________________________________

Specific Item:

___________________________________________________________________________

5. Topic: _____________________________________________________________________

Specific Item:

___________________________________________________________________________

I will do my best to complete the topics that I have chosen above.

Name: ______________________________________ Date: ____________________________

10th Grade

Starting with the first page, circle all of the “no” answers on each page. Review all of your “no” answers, and choose the five most important. Write these below, naming the topic area and the specific item you will work on.

6. Topic: _____________________________________________________________________

Specific Item: ___________________________________________________________________________

7. Topic: _____________________________________________________________________

Specific Item: ___________________________________________________________________________

8. Topic: ______________________________________________________________________

Specific Item:

___________________________________________________________________________

9. Topic: _____________________________________________________________________

Specific Item:

___________________________________________________________________________

10. Topic: _____________________________________________________________________

Specific Item:

___________________________________________________________________________

I will do my best to complete the topics that I have chosen above.

Name: ______________________________________ Date: ____________________________

11th Grade

Starting with the first page, circle all of the “no” answers on each page. Review all of your “no” answers, and choose the five most important. Write these below, naming the topic area and the specific item you will work on.

11. Topic: _____________________________________________________________________

Specific Item: ___________________________________________________________________________

12. Topic: _____________________________________________________________________

Specific Item: ___________________________________________________________________________

13. Topic: ______________________________________________________________________

Specific Item:

___________________________________________________________________________

14. Topic: _____________________________________________________________________

Specific Item:

___________________________________________________________________________

15. Topic: _____________________________________________________________________

Specific Item:

___________________________________________________________________________

I will do my best to complete the topics that I have chosen above.

Name: ______________________________________ Date: ____________________________

12th Grade

Starting with the first page, circle all of the “no” answers on each page. Review all of your “no” answers, and choose the five most important. Write these below, naming the topic area and the specific item you will work on.

16. Topic: _____________________________________________________________________

Specific Item: ___________________________________________________________________________

17. Topic: _____________________________________________________________________

Specific Item: ___________________________________________________________________________

18. Topic: ______________________________________________________________________

Specific Item:

___________________________________________________________________________

19. Topic: _____________________________________________________________________

Specific Item:

___________________________________________________________________________

20. Topic: _____________________________________________________________________

Specific Item:

___________________________________________________________________________

I will do my best to complete the topics that I have chosen above.

Name: ______________________________________ Date: ____________________________

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