If you wish, please provide your child's name.

How comfortable is your son or daughter with his or her special education placement? Very Comfortable Somewhat Comfortable Neutral Somewhat uncomfortable Very uncomfortable

How satisfied are you, as a parent, with your child's special education placement? You may add additional information, if you wish. Very Satisfied Somewhat Satisfied Neutral Somewhat Dissatisfied Very Dissatisfied

How well do you feel that you understand your child's IEP? (Please elaborate, if you wish) Very well Pretty well So-so Not well at all What's an IEP?

How well do you feel your child understands his or her IEP? Very well Pretty well So-so Understands some parts Doesn't understand it Doesn't even know what an IEP is

Which classes does your child attend in a self-contained (15:1) environment? English Social Studies Math Science

Which classes does your child attend in a integrated (consultant teacher) environment? English Social Studies Math Science None

Which teacher(s) does your child refer to most frequently in a positive way? Ms. Brennan (Soc. St.) Mrs. Evans (English) Mrs. Millen (Science) Mr. Ahearn (Science) Mrs. Price (Math) Other (please provide name) Other (please provide name) Other (please provide name) Other (please provide name) None

Which teacher(s) does your child refer to frequently in a negative way? Mrs. Brennan (Soc. St.) Mrs. Evans (English) Mrs. Millen (Science) Mr. Ahearn (Science) Mrs. Price (Math) Other (please provide name) Other (please provide name) Other (please provide name) Other (please provide name) None

What is your child's favorite subject (so far) this year? English Social Studies Math Science Foreign Language (please provide language and teacher's name)

Does your child participate in any school clubs? Yes (please list club(s)) No

Does your child participate in interscholastic sports? Yes (please list sport and season) No

Does your child have access to a computer for writing at home? (if no, skip to question 18) Yes No

Does you child have the ability to print written material from your computer? Yes No Don't have a computer

What word processing program is installed on your computer? Microsoft Word Microsoft Works Another program I don't know We don't have a computer

Does your child have access to the internet at home? Yes No We don't have a computer

Would you be able to purchase a small USB flash drive for transferring computer files from home to school? ($5-$10) Yes No I don't know what a USB flash drive is. We don't have a computer.

Does your child have a suitable place to study and do schoolwork at home? Yes No

Does your child have a regular homework time and/or routine? Yes No

Are you or another adult available to assist your child during his or her homework time? Yes No

Would you like an immediate conference to discuss your child's progress? Yes (Please provide contact name and phone # or email) No

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