JUNIOR HIGH QUESTIONNAIRE for

TRANSITION PLANNING

Student______Grade______Date______

School

Related to Employment

1. What hobbies or interests do you have?

2. Do you have a part-time job right now? _____ If so, where do you work and what do you do?

3. What other jobs have you had, either for pay or as a volunteer?

4. What do you see yourself doing after high school? (Check all that apply.)

Attend a four-year college

Attend a junior college

Attend a vocational or technical school

Enroll in the military

Go to work full time

5. Circle as many kinds of job from this list below that you think you could be trained to do and would enjoy doing if you had the needed training.

actor/actress diesel mechanic police officer

artist doctor radio/TV technician

auto body repairman electrician radiology technician

auto mechanic factory worker restaurant/fast food

beautician farmer salesperson

brick layer fashion designer secretary

broadcaster fireman security guard

bus driver garden/greenhouse worker

cafeteria worker homemaker sheet metal worker

carpenter hospital attendant teacher

cashier hotel/motel housekeeper teacher aide

child care worker hotel/motel manager telephone repairer

commercial artist landscape technician travel agent

computer operator librarian truck driver

conservation worker machine operator veterinarian

construction worker nurse veterinarian assistant

cook/chef nurses’ aide welder

custodian photographer

Related to Adult Living

1. Where do you see yourself living as an adult?

Living at home with family members

Living on my own

2. Do you order and pay for meals at a restaurant by yourself? .

3. Do you purchase items from a store by yourself? .

4. Have you ever mailed a package at a post office by yourself? .

5. Do you use the public library to check out books? . .

6. Do you make your own appointments for a hair cut? .

7. Do you have your own savings account? Checking account? .

8. Do you receive an allowance? . If so, how much and how often?

9. What are your responsibilities or chores at home?

10. If you were at home alone and there was an emergency, what would you do?

Related to Academic Needs and Accommodations

1. How do you rate your school attendance? (Circle one) Excellent Average Poor

2. How do you rate your assignment completion? (Circle one)

Always in on time Sometimes late Usually late

3. What do you feel are your academic strengths?

4. What do you feel are your academic weaknesses?

5. What is your preferred learning environment and style? (Check all that apply)

Quiet environment with less auditory stimulation

Small group or one-on-one instruction

Seated near the instructor

Seated visually away from peers

Learn by listening

Learn by doing things with my hands

Learn with visuals and demonstrations

Learn by reading