Madison County Schools’
Scottsboro City Schools
Informal Transition Inventory
Please answer the following questions to the best of your ability. If needed, you may use additional sheets of paper for your answers.
Student Questionnaire
School and General Issues
1. Do you understand your disability? Yes No
If no, what question(s) do you have? _____________________________________________________
___________________________________________________________________________________
2. How does your disability impact you? ____________________________________________________
__________________________________________________________________________________
3. How can the teachers help you in class? __________________________________________________
___________________________________________________________________________________
4. What accommodations have been successful for you, while in the general education class?__________
___________________________________________________________________________________
5. What barriers do you face while doing homework/assignments? _______________________________
___________________________________________________________________________________
___________________________________________________________________________________
6. What method(s) do you use to stay organized for school? ____________________________________
___________________________________________________________________________________
___________________________________________________________________________________
7. Where do you prefer to sit in the classroom? ______________________________________________
8. How easily are you distracted? _________________________________________________________
9. Are there specific things that distract you? ________________________________________________
__________________________________________________________________________________
10. Do you get uncomfortable when others finish their tests/assignments before you do? Yes No
11. What are your goals for after high school? _______________________________________________
_________________________________________________________________________________
12. What is required for you to reach that goal (ex. technical school, community college, university?)
__________________________________________________________________________________
13. Have you taken the ACT/SAT? Yes No
When did you take the test? _______________________What was your score? __________________
14. Have you spoken with the guidance counselor to gain information regarding attending a technical
school, community college, and/or university? Yes No
What school(s) are you interested in attending?____________________________________________
15. Have you completed any college applications? Yes No
If yes, where have you applied? ________________________________________________________
16. Are you aware of whether there is an Office of Disabled Student Services at the school you are
interested in attending? Yes No
If yes, have you contacted the office? Yes No
17. Have you registered to vote? Yes No
18. Have you registered for Selective Service? (Males Only) Yes No
19. Do you have a way to earn money now? Yes No
20. Do you have a checking or savings account? Yes No
21. Do you know your Social Security number? Yes No 22. Do you know the importance of your social security card? Yes No
23. Are you responsible for waking yourself in the morning? Yes No
How many hours of sleep do you get each night?___________________________________________
Transportation/Employment/Career Goal(s)
1. Do you have a driver’s license? Yes No
If no, do you have a driver’s permit? Yes No
2. Have you taken and passed Driver’s Education at your high school? Yes No
3. Would transportation to and from a job site be a hardship for your family? Yes No
4. Have you ever worked for someone other than family? Yes No
5. Have you completed a job application without assistance? Yes No
6. Are you presently employed? Yes No
If yes, what is the name and location of the business? _______________________________________
7. What kind of job/career do you want when you are out of school?_____________________________
__________________________________________________________________________________
8. What kind of information do you have about your career goal? _______________________________
__________________________________________________________________________________
9. Do you know where or how to research your career goal? Yes No
10. Are you familiar with the American With Disabilities Act (ADA)? Yes No
11. If an employer asks you if you have a disability, do you know whether
you have to share this information? Yes No
Socialization
1. Do you make friends easily? Yes No
2. Do you have a lot of friends? Yes No
3. What kinds of issues make you angry? ___________________________________________________
_________________________________________________________________________________
4. How do you handle your anger? _________________________________________________________
__________________________________________________________________________________
5. What kinds of events make you happy? ___________________________________________________
___________________________________________________________________________________
6. Do you feel that you get along well with other people? Yes No
If no, what kind of issue(s) have you had with other people? __________________________________
___________________________________________________________________________________
___________________________________________________________________________________
7. How much time do you spend on TV/Video games/computer? _________________________________
8. What are your favorite TV shows? _______________________________________________________
9. What are your hobbies? (Favorite activities, such as reading, TV, socializing, etc.) _________________
___________________________________________________________________________________
Living Arrangements
1. With whom do you live (parent/guardian/adult)? ____________________________________________
2. List the people who live in the home with you. _____________________________________________
__________________________________________________________________________________
3. Who is your guardian or custodial parent? _________________________________________________
4. How many siblings do you have? ________________________________________________________
5. What is your goal for your living arrangements after high school? ______________________________
___________________________________________________________________________________
(ex. Live with family/Live in my own apartment/Live in my own house/Live in a Group Home/Other)
Functional Activities
1. Can you order and pay for your own food at a restaurant? Yes No
2. Are you able to cook? Yes No
3. Can you plan a menu? Yes No
4. Are you able to do your own laundry? Yes No
5. Are you able to care for your personal hygiene? Yes No
6. Are you able to manage your personal schedule? Yes No
7. Write your phone number (including area code) ___________________________________________
8. Write your address (including the zip code) ______________________________________________
_________________________________________________________________________________
9. Do you manage your own money? Yes No
If yes, how do you manage your money? _________________________________________________
If no, who manages your money? _______________________________________________________
10. Do you use a checking account? Yes No
11. Are you able to write checks? Yes No
12. Are you able to use a debit card? Yes No
13. Who do you call in case of emergency and what are their numbers?
___________________________________ _________________ _________________
Name Number Number
___________________________________ _________________ _________________
Name Number Number
___________________________________ _________________ _________________
Name Number Number
14. What is your doctor’s name? __________________________________________________________
15. Do you have medical insurance? Yes No
16. What medical concerns or conditions do you have? ________________________________________
__________________________________________________________________________________
17. Do you take prescription medication for a condition? Yes No
If yes, do you know how to get the medication refilled? Yes No
18. Are you able to use public transportation? Yes No
19. Do you know how to report emergencies? Yes No
20. What telephone number should you dial to report an emergency? ______________________________
Additional Comments: __________________________________________________________________
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08/2008
Madison County Schools
Informal Transition Inventory
Please answer the following questions to the best of your ability. If needed, you may use additional sheets of paper for your answers.
Parent Questionnaire
1. What chores does your son/daughter do at home?____________________________________________
__________________________________________________________________________________
2. Does your son/daughter have a driver’s license? Yes No
If no, does your son/daughter have a driver’s permit? Yes No
3. Has your son/daughter taken and passed Driver’s Education at their high school? Yes No
4. What are your son/daughter’s social strengths/weaknesses?____________________________________
___________________________________________________________________________________
___________________________________________________________________________________
5. What are your son/daughter’s educational strengths/weaknesses?_______________________________
__________________________________________________________________________________
6. In what activities are they involved, outside of school? ______________________________________
_________________________________________________________________________________
7. Are you aware of and/or using STI Home? Yes No
8. Has your son/daughter ever been employed outside of the home? Yes No
If yes, please describe. _______________________________________________________________
If yes, what is the means of transportation? _______________________________________________
9. What skill(s) does your son/daughter have, with regard to school and employment?________________
__________________________________________________________________________________
__________________________________________________________________________________
10. What is a realistic educational and/or career goal for your son/daughter? ________________________
__________________________________________________________________________________
__________________________________________________________________________________
11. Can your son/daughter independently manage their personal hygiene? Yes No
12. Can your son/daughter independently manage their medical needs? Yes No
13. What is a realistic goal for your son/daughter regarding future living arrangements? _______________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
14. Are there behavioral/discipline issues within the home, community and/or school? Yes No
Please describe. _____________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Additional Comments: __________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
08/2008
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