ADNY Survey for Parents/Guardians of Children with Special Needs

Survey Introduction

The Office of the Superintendent of Schools is exploring how our Catholic schools can better serve Catholic families who have children with special needs. Currently our schools serve students with mild to moderate learning disabilities; however, there is a strong interest and desire to learn what other types of programs we should be considering.

Your willingness to take a few minutes to complete this survey is appreciated.

Do you have a child in your family or in your extended family with special learning needs?

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* 1. Do you have a child in your family or in your extended family with special learning needs?

Yes

Please indicate the student's age.

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* 2. Please indicate the student's age.

Does the student have an Individualized Educational Program (IEP) or Individualized Educational Services Plan (IESP)?

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* 3. Does the student have an Individualized Educational Program (IEP) or Individualized Educational Services Plan (IESP)?

Yes

Not Sure

What is the student's current disability classification?

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* 4. What is the student's current disability classification?

Preschooler with a Disability

Autism

Deaf-blindness

Deafness

Emotional Disturbance

Hearing Impairment

Learning Disability

Intellectual Impairment

Multiple Disabilities

Orthopedic Impairment

Other health Impairment

Speech or Language Impairment

Traumatic Brain Injury

Visual Impairment

Other

Not sure

Is the student currently in a special education program or early intervention program?

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* 5. Is the student currently in a special education program or early intervention program?

Yes

What is the student's current placement?

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* 6. What is the student's current placement?

Early intervention program

General Education class with accommodations

General Education classes with related services (e.g., speech, physical therapy, occupational therapy, counseling, etc.)

Integrated Co-teaching (2 teachers in the classroom or a SEIT)

Resource Room

Self -contained classroom 15:1:1 setting

Self -contained classroom 12:1:1 setting

Self -contained classroom 8:1:1 setting

Self -contained classroom 6:1:2 setting

Does the student receive transportation?

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* 7. Does the student receive transportation?

Yes

Are you happy with his/her program?

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* 8. Are you happy with his/her program?

Yes

Comment

If enrolled in a Catholic school that would support the services needed for the student, what tuition range would you be willing to pay?

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* 9. If enrolled in a Catholic school that would support the services needed for the student, what tuition range would you be willing to pay?

$8,000 – $10,000

$10,000 - $12,000

$12,000 – $14,000

Please indicate the level of your interest in having a Catholic School for students with special learning needs.

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* 10. Please indicate the level of your interest in having a Catholic School for students with special learning needs.

Extremely interested

Very interested

Fairly interested

Not at all interested

Please indicate the Borough/County where the student resides.

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* 11. Please indicate the Borough/County where the student resides.

Bronx

Dutchess

Manhattan

Orange

Putnam

Rockland

Staten Island

Sullivan

Ulster

Westchester

If a Catholic school for students with special learning needs were to open in your area, what type of services do you believe to be most needed? (Please check all that apply)

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* 12. If a Catholic school for students with special learning needs were to open in your area, what type of services do you believe to be most needed? (Please check all that apply)

Speech & language

Counseling

Physical therapy

Occupational therapy

ABA therapy

What grade levels should be served? (Please check those you feel are needed.)

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* 13. What grade levels should be served? (Please check those you feel are needed.)

Pre-Kindergarten 3

Pre-Kindergarten 4

Kindergarten

First Grade

Second Grade

Third Grade

Fourth Grade

Fifth Grade

Sixth Grade

Seventh Grade

Eighth Grade

High School

Any comments, thoughts or ideas you may have are welcome.

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* 14. Any comments, thoughts or ideas you may have are welcome.

If you would like to receive further information from the Archdiocese of New York about special education, please provide your name and email address.

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* 15. If you would like to receive further information from the Archdiocese of New York about special education, please provide your name and email address.

Name

Email Address