2017-18 Perkins My Transition Blueprint©️2017 versions A-S for students ages 13-22. Created 8-15-17
Email address *
My Transition Blueprint
(All) Before you begin this survey, make sure your teacher or educational aide is with you and helping you through the questions. Is your teacher or another adult helping you with the survey? *
Required
(All) Take a moment to watch this 1 minute video that explains what TRANSITION means. Click on link below. After the video ends, close the window and return to answer the questions. *
(All) What is your FIRST Name? *
type in your first name only--begin with a CAPITAL letter
Your answer
(All) What is your LAST name? *
type in your LAST name only--begin with a CAPITAL letter
Your answer
(All) Which school building do you currently attend? *
(All) What is your birth date? *
MM
/
DD
/
YYYY
(All) What is your current age? *
(All) In which year do you plan to graduate from high school? *
(All) When is your next IEP meeting? *
(ask your case manager if you do not know the date of the meeting)
MM
/
DD
/
YYYY
(All) When we meet to go over your IEP, is your IEP team also going to be reviewing a new ETR ? (Evaluation Team Report completed every 3 years) *
(ask your case manager if you do not know this answer)
(All) What are your areas of need? Have your teacher help you identify your areas of need from the list below. Listed below are skills students need to succeed in a school and work settings. Check the skills that you and your teacher believe are your AREAS OF NEED. *
AREAS OF NEED--select as many as apply
Required
(All) What do you and your teacher believe are your top 3 STRENGTHS? (list any school skills, social skills, work skills, personality traits, hands-on skills, etc. You may look at the list from the question above if you need help to start thinking of your different strengths, however you can list strengths not found on the list above--like "sense of humor" or "hard-working" or "respectful") *
Your answer
(All) How do you best learn a new task? What is your preferred learning style? *
(All) Do you believe you are ready to live on your own right now? *
Honestly rate yourself on a scale of 1-10
No way! I still have lots to learn and lots of growing up to do.
Yes! I am totally ready & able to live on my own without parent/family support.
(All) Look at the independent living skills below and choose the skills that you STILL NEED TO LEARN or IMPROVE UPON before you will be ready to live on your own. *
Required
(All) After graduation from high school (within 6 months) in which of these settings do you think you will be living? *
Choose one setting from the list below
(All) Which grade are you in currently? *
Next
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms