Parent/Guardian Transition Questionnaire

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?______

______

______