The purpose of this survey is to learn your perspective about your child’s educational planning and services in his /her school setting. Information you provide will inform PEAK Parent Center as to how best to increase access to and provide information and supports that improve quality of services for children with disabilities and their families. We appreciate your time in completing this survey and assure you of confidentiality and that all information gathered will be used in aggregate and no one individual response will be identifiable. Again, we thank you for your important information. If you would like to receive this survey in Spanish, please email pmaycott@peakparent.org

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* 1. Are you family member of a child with a disability?

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* 2. Age of child/children with a disability?

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* 3. My child’s primary disability as defined by federal definitions:

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* 4. I would identify myself as culturally or racially diverse? (optional)

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* 5. Do you speak a language other than English?

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* 6. Zipcode:

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* 7. What answer below best describes your community?

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* 8. Placement/location of services for your children:

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* 9. I have access to the information and training I need to support my child

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* 10. I believe that

  Hardly Ever Sometimes Frequently Always
I am seen as an equal partner and an informed decision maker on my child’s school team.
The school team understands my perspective as a parent/family member.
I have access to the services and supports that my child needs.

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* 11. To what degree are you satisfied with your school’s efforts to engage parents and educators to work together in your child’s education planning?

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* 12. I would find information on the following topics helpful: Check all that apply.

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* 13. In my opinion, the biggest challenge accessing the educational system in Colorado is:

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* 14. If you have used PEAK services in the past 12 months, please rate the following statements:

  Did not use Do not agree Somewhat agree Agree Highly agree
Involvement with PEAK has increased my knowledge of IDEA and how to support my child's educational planning.
PEAK services, information and supports are of high quality.
PEAK's information and support is highly useful in supporting my child and family.

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* 15. What are the best ways for PEAK to share information with you? (Check all that apply)

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* 16. Please check all that apply

  Hardly ever Three times a week All of the time
I have access to a computer
I have access to the internet

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* 17. Please check all that apply:

Thank you again for providing valuable information to direct our efforts!

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