PARENT TRANSITION SURVEY
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TimestampStudent Name:Date1. Type of special education program your son/daughter is in:If other health impairments or other, please explain:2. How old is your son/daughter now? 3. At what age do you anticipate or plan for your son/daughter to graduate?4. In what area does your child have the greatest needs? Please check all that apply.Rank #1Rank #2Rank #3Rank #4Rank #51. Future education for my son/daughter will be:If other, please explain:1. I think my son/daughter will work in:If other, please specify:2. What type of work does your son/daughter state that he/she is interested in?3. Do you feel this is a realistic goal?4. What type of employment do you think he/she would enjoy? 5. What type of support or assistance do you think your son/daughter will need in finding and maintaining a job? (Check all that apply.)1. Five years after school, where do you want your son/daughter to live?If other, please specify:2. Concerns that you have about your son/daughter living on his/her own: (Check all that apply)If other, please specify:1. After graduation, how do you want your son/daughter to be supported? (check all that apply):2. Do you think that when your son/daughter turns 18 years old, he/she will be:3. Have you prepared (trust fund) for the future for your son/daughter? 4. Have you prepared a will that includes plans for your son/daughter?1. Do you think your son/daughter will get a drivers license? 2. After graduation, will your son/daughter travel around town by: (Check all that apply)1. When my son/daughter graduates, I hope he/she will be involved in: (Check all that apply)2. After graduation, do you feel your son/daughter will probably: (check all that apply)1. Please check the following services that you are aware of.Please explains other(s)2. Next, indicate which of these services you have contacted or had contact with in the past.Please explains other(s)3. Finally, Indicate the services you would like more information.Please explains other(s)
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12/5/2011 7:42:12Mary Smith12/5/2011Learning disabilities17academic skills needed for postsecondary education, problem-solving skills, vocational and career exploration (opportunities to experience and learn about several different types of careers and/or jobsvocational and career exploration (opportunities to experience and learn about several different types of careers and/or jobsacademic skills needed for postsecondary educationproblem-solving skillsacademic skills needed for postsecondary educationacademic skills needed for postsecondary educationFour year college/universityFull-time competitive employment (find and keep a job on his/her own)She doesn't knowNOsaleshelp finding a jobin an apartment on their own – with roommate(s) has been too dependentHis/her own wages, Your financial supporthis or her own legal guardianNOYESYEScity busActivities with friendsHave a boy/girl friend, but no marriageVocational Rehabilitation, Social Security Administration, Social and Rehabilitative Services (SRS)Job Services
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12/5/2011 9:19:22Samantha Eubanks12/5/2011Learning disabilitiesSpeech Impaired17age 18academic skills needed for postsecondary education, basic academic skills (reading, writing, arithmetic), communication skills (ability to express oneself to others), friendships and social relationships, meal planning, preparation, & cleaning up, money management skills, shopping skills (comparison shopping, handling money, etc.), vocational and career exploration (opportunities to experience and learn about several different types of careers and/or jobsbasic academic skills (reading, writing, arithmetic)communication skills (ability to express oneself to others)decision making/ goal setting/ skills for self-advocacyacademic skills needed for postsecondary educationrecreational/leisure skillsOn-the-job trainingPart-time competitive employmentchild careYESworking with peoplehelp finding a job, assistance only when problems or new situations ariseat homecan’t shop on own, can’t manage money, not ready yet to live in the community, will be lonelySocial Security/ SSI/ SSDI, His/her own wages, Your financial supportwill need a conservator for financial decisionsNONONOwalk, getting rides in the family car or with friendsActivities with friends, Organized recreational activities (clubs, team sports), Integrated activities (team members with and without disabilities)Have very little romantic or social contact with the opposite sexVocational Rehabilitation, Vocational Rehabilitation CentersVocational Rehabilitation, Other(s)The Gulf Coast CenterCenters for Independent Living
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12/7/2011 16:37:52Test12/7/2011Other 19uncertainacademic skills needed for postsecondary education, basic academic skills (reading, writing, arithmetic), cleaning house, communication skills (ability to express oneself to others), decision making/ goal setting/ skills for self-advocacy, friendships and social relationships, meal planning, preparation, & cleaning up, money management skills, personal care needs (grooming, shaving, dressing skills etc.), problem-solving skills, recreational/leisure skills, shopping skills (comparison shopping, handling money, etc.), travel skills (pedestrian, public &/or private transportation), vocational and career exploration (opportunities to experience and learn about several different types of careers and/or jobs, washing clothes, folding, etc.cleaning housebasic academic skills (reading, writing, arithmetic)money management skillscommunication skills (ability to express oneself to others)travel skills (pedestrian, public &/or private transportation)Don’t knowSupported employment (community job for real wages with supports to find and keep a job)Test for vocational experienceNOTest 2: Realistic goalhelp finding a job, time-limited support to learn the job (extra training), long-term support needed to learn the job (ongoing training)in a supported apartment/living program – with roommate(s)can’t shop on own, can’t manage money, not ready yet to live in the community, has been too dependent, won’t take good care of self, will be lonely, will be exploited (sexual, physical, financial)Social Security/ SSI/ SSDI, His/her own wages, General relief (food stamps, subsidized housing, etc.), Your financial supportnot sure/don’t knowNONONObicycle, walk, car pool, city bus, city cab, getting rides in the family car or with friendsActivities with friends, Friends with disabilities, Friends without disabilities, Organized recreational activities (clubs, team sports), Integrated activities (team members with and without disabilities), Classes (to develop hobbies, and explore areas of interest)Have a boy/girl friend, but no marriageSocial Security Administration, Respite CareVocational Rehabilitation, Job Training Partnership Act (JTPA), Job Services, Vocational Rehabilitation Centers, Targeted Jobs Tax Credits, Social Security Administration, Social and Rehabilitative Services (SRS), Centers for Independent Living, Respite Care, Home & Community-based Services Medicaid Waivers (HCBS), Food Stamps
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6/12/2014 19:30:55jlkajd5/8/2014academic skills needed for postsecondary educationacademic skills needed for postsecondary educationacademic skills needed for postsecondary educationacademic skills needed for postsecondary educationacademic skills needed for postsecondary education
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5/20/2015 8:18:53Ryan Wallace05/20/2015Other health impairments17age 18academic skills needed for postsecondary education, decision making/ goal setting/ skills for self-advocacyacademic skills needed for postsecondary educationdecision making/ goal setting/ skills for self-advocacyVocational technical schoolFull-time competitive employment (find and keep a job on his/her own)AutomotiveYESHands onwill not need any supportin an apartment on their own – with roommate(s) His/her own wageshis or her own legal guardianNONOYESotherRecreational activities that he/she does aloneGet married, Have Children
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5/21/2015 18:29:45Jared Johnston5-21-2015Learning disabilitiesN/A17age 18academic skills needed for postsecondary education, basic academic skills (reading, writing, arithmetic), decision making/ goal setting/ skills for self-advocacy, problem-solving skills, vocational and career exploration (opportunities to experience and learn about several different types of careers and/or jobsacademic skills needed for postsecondary educationbasic academic skills (reading, writing, arithmetic)decision making/ goal setting/ skills for self-advocacyproblem-solving skillsvocational and career exploration (opportunities to experience and learn about several different types of careers and/or jobsOther:We don't know for sure but he is talking about beginning in technical school of an A.A. and then go from there.Full-time competitive employment (find and keep a job on his/her own)Agricultural. Turf management landscaping.YESWe feel he would enjoy working on or selling Agricultural equipment. He also has a natural talent with drumming.help finding a jobin an apartment on their own – alone not really concerned I don’t knowhis or her own legal guardianNONOYEShis/her own carRecreational activities that he/she does alone, Activities with friends, Organized recreational activities (clubs, team sports), Integrated activities (team members with and without disabilities), Classes (to develop hobbies, and explore areas of interest)Get married, Have ChildrenJob Services, Social Security Administration, Visiting Nurses Association, Respite CareNone None
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