Special Education Survey (18-19)
In an attempt to categorize our services, it is necessary to collect private data about our participants. For example, grant opportunities often ask, "What percentage of your participants have Autism Spectrum Disorder?" We have no desire to track individual students or put privacy at risk. That is why this form relates to no specific student, school, or teacher.

Thank you so much for your help!

School Name (only used to keep track of those that have completed this form. Will NOT be used for external reporting.) *
Your answer
What is the total number of New Musicians participating in United Sound at your school? *
Your answer
Please indicate the number of students who fall into each category. Many people have multiple diagnoses, so your total will likely not equal the number of New Musicians at your school.
Form will not accept blanks. Enter 0 for "none."
Vision Impairment *
Hearing Loss *
Autism Spectrum Disorder *
Cerebral Palsy *
Down Syndrome *
Learning Disability (LD) *
Traumatic Brain Injury *
Attention-Deficit/ Hyperactivity Disorder (ADHD) *
Central Auditory Processing Disorder (CAPD) *
Bipolar Disorder *
Williams Syndrome *
Other? Please indicate diagnoses and number.
Your answer
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