PARENT/GUARDIAN TRANSITION QUESTIONNAIRE
LIFESKILLS TRANSITION PLANNING
Student Name ______Date ______
Telephone Number ______Expected Year of Graduation ______
For the school to work with you and other agencies in getting your child ready for the world of work, the following information would be helpful for transition planning:
Other agencies involved with your daughter/son either currently or projected after graduation______
______
I. Vocational Needs
1. When she/he graduates from the public school, we would like our daughter/son to participate in:
____ Day Care/Activity Program ____ Supported Full-time
____ Sheltered Workshop ____ Competitive Part-time
____ Supported Part-time Employment ____ Competitive Full-time
____ Other (Specify) ______
2. In which kind of job(s) does you daughter/son seem interested? ______
______
3. What kinds of jobs does she/he like? ______
______
4. Do you have a preference for occupational placement?______
5. Are there jobs in which you object to your daughter/son’s placement? If so, what? ______
______
6. If there are any medical concerns relating to your daughter/son/s vocational placement?
______
7. What skills to you think need to be developed to help you daughter/son reach her/his vocational goals?
______
II. Community Living (Please check one from the list)
____ Live independently in an apartment or home ____ Supervised apartment
____ With family member (who?) ______Group home
____ With support ____ Other, please describe
______
III. Recreational and Leisure Options
A. Leisure Interest Inventory
Check all of the following leisure activities in which your son or daughter currently spends free time:
_____ Swimming _____ Lifting weights _____ Skiing (winter sports)
_____ Running ______Fishing ______Camping
_____ Softball _____ Basketball _____ Riding motorcycle
Attends Large Group Events
____ movies ____ ball games
____ music events ____ school dances
Individual Activities
____ handcrafts ____ listening music ____ caring for pets
____ talking on phone ____ watching TV ____ playing cards or board games
Participates in Social Activities
____ dating ____ picnic ____ dancing
____ eating out ____ spending time with family or friends
____ attending church ____ other ______
IV. Transportation Options
How will you daughter or son get around the community and to work?
Does Now Needs to Learn
drive own vehicle ______------
use SEPTA bus transportation ______------
ride a bicycle ______------
walk ______------
use special transportation system ______------
depend on others ______------
Are you willing to drive your daughter or son to work? ____ Yes ____ No
V. Financial Support
A. Does your daughter or son need financial assistance in any of the following areas to reach her or his
long-range goals?
1. Post-Secondary education ____ Yes ____ No
If yes, please check all of the following for which you would like additional information.
____ Office of Vocational Rehabilitation ____ Supplemental Security Income (SSI)
____ BARC ____ Social Security Disability Insurance (SSDI)
2. Employment Assistance ____ Yes ____ No
If yes, please check all of the following for which you would like additional information.
____ Office of Vocational Rehabilitation ____ AHEDD
____ Associated Production Services ____ MH/DP
3. Home living assistance ____ Yes ____ No
If yes, please check all of the following for which you would like additional information.
____ County social services ____ Housing assistance
____ Independent living centers ____ Community Options
VI. Health-Related Needs
A. Does your child currently have any of the following needs?
____ medical (i.e., medications) ____ yes* ____ no
____ counseling ____ yes* ____ no
* Please explain ______
______
B. Currently, what is your greatest future concern for you daughter or son?______
______
______