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: __________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

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

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download