PEN Service and Needs Assessment
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PEN is a federally funded Parent Training and Information Center (PTI). Annually, we evaluate how our services are addressing parent needs and how we can better provide services to professionals serving children and youth with disabilities. We also want to improve the delivery of our services to you and your child. Please complete the following survey to help us better serve you, your agency and the educational community.

1. Are you a :

Are you a :

Other (please specify)

2. County of Residence – Select One

County of Residence – Select One

Other (please specify)

3. If you are a parent – what is your child’s primary disability? - Select one

If you are a parent – what is your child’s primary disability? - Select one

Other (please specify)

4. If you are a parent – Age of Child

If you are a parent – Age of Child

5. Do you live in a : Select One

Do you live in a : Select One Rural area

Suburban area

City area

6. How do you obtain information about Special Education/Disability? Check all that apply.

How do you obtain information about Special Education/Disability? Check all that apply. Internet

Newsletters

Disability Support Groups

Agencies

School

Doctor

Other (please specify)

7. Do you attend workshops/conferences regarding special education/disability specific issues?

Do you attend workshops/conferences regarding special education/disability specific issues? Yes

8. How often?

How often? 1-2 per year

3-6 per year

6 or more per year

9. How do you prefer to receive trainings?

How do you prefer to receive trainings? Face – to – face (in person)

Webinar

Both

10. Are you interested in web social networking/training opportunities?

Are you interested in web social networking/training opportunities? Yes

11. Is your youth/young adult interested in web social networking/training opportunities?

Is your youth/young adult interested in web social networking/training opportunities? Yes

12. Do you prefer to attend and participate in workshops/webinars?

Do you prefer to attend and participate in workshops/webinars? Day time hours

Night time hours

Week Day

Weekend

13. In advocating for a child with a disability, do you have any of the following needs for trainings, information and resources?
Select 6. Please prioritize your answers by using numbers 1 (most important) through 6 (least important).

	1 (Most important)	2	3	4	5	6-(Least important)
Understanding the child’s disability	*In advocating for a child with a disability, do you have any of the following needs for trainings, information and resources? Select 6. Please prioritize your answers by using numbers 1 (most important) through 6 (least important). Understanding the child’s disability 1 (Most important)	Understanding the child’s disability 2	Understanding the child’s disability 3	Understanding the child’s disability 4	Understanding the child’s disability 5	Understanding the child’s disability 6-(Least important)
Understanding the child’s learning/behavioral needs	Understanding the child’s learning/behavioral needs 1 (Most important)	Understanding the child’s learning/behavioral needs 2	Understanding the child’s learning/behavioral needs 3	Understanding the child’s learning/behavioral needs 4	Understanding the child’s learning/behavioral needs 5	Understanding the child’s learning/behavioral needs 6-(Least important)
Developing more effective communication skills	Developing more effective communication skills 1 (Most important)	Developing more effective communication skills 2	Developing more effective communication skills 3	Developing more effective communication skills 4	Developing more effective communication skills 5	Developing more effective communication skills 6-(Least important)
Understanding the special education laws	Understanding the special education laws 1 (Most important)	Understanding the special education laws 2	Understanding the special education laws 3	Understanding the special education laws 4	Understanding the special education laws 5	Understanding the special education laws 6-(Least important)
Understanding the child’s test results	Understanding the child’s test results 1 (Most important)	Understanding the child’s test results 2	Understanding the child’s test results 3	Understanding the child’s test results 4	Understanding the child’s test results 5	Understanding the child’s test results 6-(Least important)
Understanding the various agencies involved in transition from school	Understanding the various agencies involved in transition from school 1 (Most important)	Understanding the various agencies involved in transition from school 2	Understanding the various agencies involved in transition from school 3	Understanding the various agencies involved in transition from school 4	Understanding the various agencies involved in transition from school 5	Understanding the various agencies involved in transition from school 6-(Least important)
Understanding the procedural safeguards	Understanding the procedural safeguards 1 (Most important)	Understanding the procedural safeguards 2	Understanding the procedural safeguards 3	Understanding the procedural safeguards 4	Understanding the procedural safeguards 5	Understanding the procedural safeguards 6-(Least important)
Determining whether the child is benefiting and making progress	Determining whether the child is benefiting and making progress 1 (Most important)	Determining whether the child is benefiting and making progress 2	Determining whether the child is benefiting and making progress 3	Determining whether the child is benefiting and making progress 4	Determining whether the child is benefiting and making progress 5	Determining whether the child is benefiting and making progress 6-(Least important)
Understanding more about Assistive Technology	Understanding more about Assistive Technology 1 (Most important)	Understanding more about Assistive Technology 2	Understanding more about Assistive Technology 3	Understanding more about Assistive Technology 4	Understanding more about Assistive Technology 5	Understanding more about Assistive Technology 6-(Least important)
Developing an effective IEP	Developing an effective IEP 1 (Most important)	Developing an effective IEP 2	Developing an effective IEP 3	Developing an effective IEP 4	Developing an effective IEP 5	Developing an effective IEP 6-(Least important)
How to improve effective learning opportunities in the Least Restrictive Environment (LRE)	How to improve effective learning opportunities in the Least Restrictive Environment (LRE) 1 (Most important)	How to improve effective learning opportunities in the Least Restrictive Environment (LRE) 2	How to improve effective learning opportunities in the Least Restrictive Environment (LRE) 3	How to improve effective learning opportunities in the Least Restrictive Environment (LRE) 4	How to improve effective learning opportunities in the Least Restrictive Environment (LRE) 5	How to improve effective learning opportunities in the Least Restrictive Environment (LRE) 6-(Least important)

Other (please specify)

14. How much do you know about Response to Intervention (RTII) in Pennsylvania?

How much do you know about Response to Intervention (RTII) in Pennsylvania? Well informed

Some

None

15. How much do you know about Restraint/Seclusion in Pennsylvania?

How much do you know about Restraint/Seclusion in Pennsylvania? Well informed

Some

None

16. How much do you know about Wrap-around and Mental Health services?

How much do you know about Wrap-around and Mental Health services? Well informed

Some

None

17. Additional Comments

Additional Comments

Thank You for completing our survey!!!

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PEN Service and Needs AssessmentExit this survey

1. Are you a :

2. County of Residence – Select One

3. If you are a parent – what is your child’s primary disability? - Select one

4. If you are a parent – Age of Child

5. Do you live in a : Select One

6. How do you obtain information about Special Education/Disability? Check all that apply.

7. Do you attend workshops/conferences regarding special education/disability specific issues?

8. How often?

9. How do you prefer to receive trainings?

10. Are you interested in web social networking/training opportunities?

11. Is your youth/young adult interested in web social networking/training opportunities?

12. Do you prefer to attend and participate in workshops/webinars?

13. In advocating for a child with a disability, do you have any of the following needs for trainings, information and resources?Select 6. Please prioritize your answers by using numbers 1 (most important) through 6 (least important).

14. How much do you know about Response to Intervention (RTII) in Pennsylvania?

15. How much do you know about Restraint/Seclusion in Pennsylvania?

16. How much do you know about Wrap-around and Mental Health services?

17. Additional Comments

PEN Service and Needs Assessment
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13. In advocating for a child with a disability, do you have any of the following needs for trainings, information and resources?
Select 6. Please prioritize your answers by using numbers 1 (most important) through 6 (least important).