Annotated Instructions
The following annotated instruction correlate to the 2010-11 PaPOS Exit Survey. Please review prior to conducting the PaPOS Exit Survey with your student leavers.
Administrative Considerations
Ø The Exit Survey should be administered in an interview fashion by an individual familiar with the student being interviewed.
Ø If a student’s disability limits his/her ability to respond accurately to the survey questions, an individual (e.g., family member, provider agency staff, etc.) can assist the student in answering the student survey questions.
Ø At the conclusion of the survey, make a copy of the completed survey. Mail the original survey to PaTTAN Pittsburgh based on the schedule provided in the 2010-11 Pennsylvania Post School Outcomes Survey Timeline & Procedures document. The Timeline & Procedures document is included in your material’s packet.
Ø Your packet includes both Pre-populated student surveys and blank surveys. The first two pages of instructions for these surveys differ. However, pages 3-5 are identical.
Pre-populated Forms – Pages 1-2
Targeted Students:
Information on students ages 17 – 21 was retrieved from the most recent PennData records. Data were placed into the exit surveys and separate surveys were generated for each potential leaver.
Leavers: include any student with an IEP who graduates with a high school diploma, dropouts, reaches maximum age or receives a GED during the 2010-2011 school year.
Graduate with a high school diploma: includes any student with an IEP who graduated with a diploma between September 1, 2010 and June 30, 2011.
Dropouts: include any student with an IEP who dropped out of school between September 1, 2010 and June 30, 2011.
Reach maximum age: include any student with an IEP who reaches the age of 21 between September 1, 2010 and June 30, 2011. If a student leaves because he/she reaches maximum age, select this option rather than ‘Graduates with a high school diploma’.
Receive a GED: include any student with an IEP who receives a GED between September 1, 2010 and June 30, 2011.
Students leaving under other circumstances
If a student is no longer attending your school, but does not meet any of the definitions above, place a note on the front of the survey indicating the reason that the student no longer attends school and the date of the change (e.g., moved to another district or out of state, no longer has an IEP, deceased, was a leaver prior to September, 2010, etc.)
Answer question 3 (Is the student a “leaver” for this year?):
Before reviewing the demographic information, review each Prepopulated Exit Survey and indicate in Question # 3 if the student is a “leaver” for this year.
Not a Leaver:
If the student did not leave school in 2010-11, the answer to question # 3 is “No.” The exit survey for this student is complete and should be submitted to PaTTAN Pittsburgh following the instructions on the 2010-11 Pennsylvania Post School Outcomes Survey Timeline & Procedures document included in your materials packet. Please note that surveys for all students (leavers and non-leavers) must be returned to PaTTAN Pittsburgh.
3. / Is this student a “leaver” for this year? / No / X / Stop! You have completed this survey and may submit. Thank you for participating.Yes / (If yes, go to question # 4)
Answer question 4 if the student is a leaver:
If the answer to question #3 is “Yes,” indicate the date that the student exited or is expected to exit school during the 2010-11 school year. Record the date as MM/DD/YYYY.
4. / Date student exited schoolMM/DD/YYYY / 02/10/2011
Answer question 5:
Identify the manner in which the student exited or will exit school. Select only one option.
Check only ONE option5. / Manner in which student will exit school / Graduate with a high school diploma
Drop-out / X
Reach maximum age
Receive a GED
Review and correct student demographics:
A) If the student is a leaver, review the information included from PennData. The data include the student’s last and first name (Questions 1 and 2) and other demographic information including District of Residence*, PA Secure ID, Date of Birth, Gender, Primary Special Education Disability, Ethnicity, (Questions 6-11).
* Surveys in the Philadelphia SD include the name of the school along with the District.
B) If any of the demographic information is inaccurate, make corrections in the column entitled “Corrections.” If any information is missing from these fields (e.g., Pre-populated PA Secure ID is blank), record the information in the column entitled “Corrections.”
6. / District of Residence (LEA) / Prepopulated / CorrectionsPittsburgh SD
7. / PA Secure ID / 875555555 / 875598098
Blank Forms – Pages 1-2
You received 5 “Blank” forms entitled: Pennsylvania Exit Survey Blank Form (For Leavers who do not have a prepopulated form). These surveys have district-specific information (District of Residence and AUN), but no student specific information. You will need to make more copies of the blank forms if you have more than 5 students.
Leavers: include any student with an IEP who graduates with a high school diploma, dropouts, reaches maximum age or receives a GED during the 2010-2011 school year.
Enter Student Demographic Information:
If you have a student who is a leaver and who does not have a pre-populated form, use a blank form and record the student demographics (Last Name, First Name, PA Secure ID, Date of Birth, Gender, Primary Disability, Ethnicity, Questions 1, 2, and 6-11). Please be certain that there is no existing pre-populated form for the student.
This information should match the student’s record within the PennData system (Questions 6-11).
Student Demographic Information1. / Student Last Name / Northman
2. / Student First Name / Eric
Answer question 3 (Is the student a “leaver” for this year?) You will only need to fill out a Blank Exit survey if the student is a leaver this year. Please answer question #3 as yes.
Yes
Answer question 4 if the student is a leaver:
If the answer to question #3 is “Yes,” indicate the date that the student exited or is expected to exit school during the 2010-11 school year. Record the date as MM/DD/YYYY.
Answer question 5:
Identify the manner in which the student exited or will exit school. Select only one option.
Check only ONE option5. / Manner in which student will exit school / Graduate with a high school diploma
Drop-out / X
Reach maximum age
Receive a GED
Pre-populated and Blank Forms – Page 3
Answer each of the next 3 questions based on the Student’s Most Recent IEP:
In this section, you should record Post School outcomes based on the student’s most recent IEP for all students who are leavers.
Locate the student’s current IEP. Find Section 3 - Secondary Transition Activities and Services (the grid). Record one outcome for each question (12-14). Be sure to respond to each question. Each has the option of ‘None’ or ‘Not Applicable’ which allows everyone to respond to every question.
Check only ONE option13. / What employment post secondary goal is included in this student’s IEP for the period immediately following high school? / Competitive employment / X
Military
Employed in family business
Self-employment
Supported employment (paid work in a community setting for those needing continuous support services)
Sheltered employment (where most workers have disabilities)
Employment that allows for technological and medical supports
The IEP team has determined that this post-secondary goal is not applicable for the student
Pre-populated and Blank Forms – Page 4
Exit Survey Student Questions (page 4)
This section includes questions about classes, activities, and accommodations received in high school. You may check all options that apply.
Questions 15-16
Answer each of the questions on page 4. If the student is unsure of any answer, refer to the student’s most recent IEP or school record for assistance. If an item with “please describe” is selected, be sure to add clarifying information in the space provided. You have the option of answering “None” on question 16 if no accommodations were received.
Check ALL that apply15. / Identify each class/activity in which you took part in high school. / Career/technology education (vo-tech) / X
Community-based work instruction
Community-based life skills instruction / X
Unpaid work experience
Paid work experience
College prep
Academic instruction / X
Pre-populated and Blank Forms – Page 5
Contact information after leaving high school
Next year, the LEA is required to complete the PaPOS Post-School Survey for each 2010-11 student leaver. Accurate contact information is critical for the LEA to follow up with these students. Contact information should be recorded for the student and a primary contact (the “best” or “emergency” contact), who must be someone other than the student. If any information is not applicable (e.g., the student or contact does not have a cell phone), enter N/A.
N/A. Be sure to record the information fully (e.g., area codes with the phone numbers).
Student InformationHome Phone: / (333)555-1212 / Cell Phone: / (333)121-5555
Email address: /
Street address: / 12 First St.
City: / Erie / State: / PA / Zip Code: / 15432
Primary contact other than student
Last Name: / Doe
First Name: / Jane
Relationship to Student: / Mother
Home Phone: / (333) 555-1212 / Cell Phone: / (333) 523-1234
Email address: /
Street Address: / 12 First St.
City: / Erie / State: / PA / Zip Code: / 15432
Interviewer Information:
This information will be used if a follow-up is needed. Provide the contact information for the person completing the exit survey with the student. Also, choose the interviewer’s primary role. Select only one option – the interviewer’s primary role.
Person Conducting InterviewLast Name: / Jones
First Name: / Harry
Phone: / (333)442-9090 / Email address: /
Check only ONE option
Primary Role of Interviewer / Teacher / X
Administrator
Transition personnel
Paraprofessional/ education assistant
School psychologist
School counselor
Other
Please describe: ______
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