S.O.A.R. 2023 Teacher of the Visually Impaired Pre-S.O.A.R. Participant Assessment Survey

Question Title

* 1. Please enter your contact information

Name

Email Address

Phone Number

Question Title

* 3. Please complete the Likert Scale below assessing the skill sets of the applicant named above. Please provide additional insights through the "Comments" section to identify other areas of strength, challenge and/or other information you feel is relevant when considering their application for S.O.A.R.

	Completely Independent	I Need a Little Bit of Help Sometimes	I Need a Lot of Help Most of the Time	I Have Never Tried	N/A
Use of large Kitchen Appliances (stove top, oven, grill, etc.)	Use of large Kitchen Appliances (stove top, oven, grill, etc.) Completely Independent	Use of large Kitchen Appliances (stove top, oven, grill, etc.) I Need a Little Bit of Help Sometimes	Use of large Kitchen Appliances (stove top, oven, grill, etc.) I Need a Lot of Help Most of the Time	Use of large Kitchen Appliances (stove top, oven, grill, etc.) I Have Never Tried	Use of large Kitchen Appliances (stove top, oven, grill, etc.) N/A
Use of small Kitchen Appliances (microwave, blender, toaster, etc.)	Use of small Kitchen Appliances (microwave, blender, toaster, etc.) Completely Independent	Use of small Kitchen Appliances (microwave, blender, toaster, etc.) I Need a Little Bit of Help Sometimes	Use of small Kitchen Appliances (microwave, blender, toaster, etc.) I Need a Lot of Help Most of the Time	Use of small Kitchen Appliances (microwave, blender, toaster, etc.) I Have Never Tried	Use of small Kitchen Appliances (microwave, blender, toaster, etc.) N/A
Recipe Use / Meal Planning	Recipe Use / Meal Planning Completely Independent	Recipe Use / Meal Planning I Need a Little Bit of Help Sometimes	Recipe Use / Meal Planning I Need a Lot of Help Most of the Time	Recipe Use / Meal Planning I Have Never Tried	Recipe Use / Meal Planning N/A
Knife Skills - Slice, chop, spread	Knife Skills - Slice, chop, spread Completely Independent	Knife Skills - Slice, chop, spread I Need a Little Bit of Help Sometimes	Knife Skills - Slice, chop, spread I Need a Lot of Help Most of the Time	Knife Skills - Slice, chop, spread I Have Never Tried	Knife Skills - Slice, chop, spread N/A
Eating Etiquette - Scooping, serving, ladle, tongs	Eating Etiquette - Scooping, serving, ladle, tongs Completely Independent	Eating Etiquette - Scooping, serving, ladle, tongs I Need a Little Bit of Help Sometimes	Eating Etiquette - Scooping, serving, ladle, tongs I Need a Lot of Help Most of the Time	Eating Etiquette - Scooping, serving, ladle, tongs I Have Never Tried	Eating Etiquette - Scooping, serving, ladle, tongs N/A
Table Etiquette - Table setting, utensil use	Table Etiquette - Table setting, utensil use Completely Independent	Table Etiquette - Table setting, utensil use I Need a Little Bit of Help Sometimes	Table Etiquette - Table setting, utensil use I Need a Lot of Help Most of the Time	Table Etiquette - Table setting, utensil use I Have Never Tried	Table Etiquette - Table setting, utensil use N/A
Food Safety - Temperatures, sanitation/cleaning	Food Safety - Temperatures, sanitation/cleaning Completely Independent	Food Safety - Temperatures, sanitation/cleaning I Need a Little Bit of Help Sometimes	Food Safety - Temperatures, sanitation/cleaning I Need a Lot of Help Most of the Time	Food Safety - Temperatures, sanitation/cleaning I Have Never Tried	Food Safety - Temperatures, sanitation/cleaning N/A
Trash Disposal & Recycling	Trash Disposal & Recycling Completely Independent	Trash Disposal & Recycling I Need a Little Bit of Help Sometimes	Trash Disposal & Recycling I Need a Lot of Help Most of the Time	Trash Disposal & Recycling I Have Never Tried	Trash Disposal & Recycling N/A
Kitchen Maintenance - Washing dishes, using dishwasher, dish drying	Kitchen Maintenance - Washing dishes, using dishwasher, dish drying Completely Independent	Kitchen Maintenance - Washing dishes, using dishwasher, dish drying I Need a Little Bit of Help Sometimes	Kitchen Maintenance - Washing dishes, using dishwasher, dish drying I Need a Lot of Help Most of the Time	Kitchen Maintenance - Washing dishes, using dishwasher, dish drying I Have Never Tried	Kitchen Maintenance - Washing dishes, using dishwasher, dish drying N/A
Kitchen Management - Labeling, organization, shopping list	Kitchen Management - Labeling, organization, shopping list Completely Independent	Kitchen Management - Labeling, organization, shopping list I Need a Little Bit of Help Sometimes	Kitchen Management - Labeling, organization, shopping list I Need a Lot of Help Most of the Time	Kitchen Management - Labeling, organization, shopping list I Have Never Tried	Kitchen Management - Labeling, organization, shopping list N/A
Home Maintenance - Vacuuming, dusting, sweeping	Home Maintenance - Vacuuming, dusting, sweeping Completely Independent	Home Maintenance - Vacuuming, dusting, sweeping I Need a Little Bit of Help Sometimes	Home Maintenance - Vacuuming, dusting, sweeping I Need a Lot of Help Most of the Time	Home Maintenance - Vacuuming, dusting, sweeping I Have Never Tried	Home Maintenance - Vacuuming, dusting, sweeping N/A
Bed-Making - Fitted sheet, flat sheet, skirt	Bed-Making - Fitted sheet, flat sheet, skirt Completely Independent	Bed-Making - Fitted sheet, flat sheet, skirt I Need a Little Bit of Help Sometimes	Bed-Making - Fitted sheet, flat sheet, skirt I Need a Lot of Help Most of the Time	Bed-Making - Fitted sheet, flat sheet, skirt I Have Never Tried	Bed-Making - Fitted sheet, flat sheet, skirt N/A
Bathroom Maintenance - Cleaning toilets, bathtub, sink; plunger, shower curtain	Bathroom Maintenance - Cleaning toilets, bathtub, sink; plunger, shower curtain Completely Independent	Bathroom Maintenance - Cleaning toilets, bathtub, sink; plunger, shower curtain I Need a Little Bit of Help Sometimes	Bathroom Maintenance - Cleaning toilets, bathtub, sink; plunger, shower curtain I Need a Lot of Help Most of the Time	Bathroom Maintenance - Cleaning toilets, bathtub, sink; plunger, shower curtain I Have Never Tried	Bathroom Maintenance - Cleaning toilets, bathtub, sink; plunger, shower curtain N/A
Laundry - Washing machine and dryer	Laundry - Washing machine and dryer Completely Independent	Laundry - Washing machine and dryer I Need a Little Bit of Help Sometimes	Laundry - Washing machine and dryer I Need a Lot of Help Most of the Time	Laundry - Washing machine and dryer I Have Never Tried	Laundry - Washing machine and dryer N/A
Laundry - Clothes Labeling, sorting, organization	Laundry - Clothes Labeling, sorting, organization Completely Independent	Laundry - Clothes Labeling, sorting, organization I Need a Little Bit of Help Sometimes	Laundry - Clothes Labeling, sorting, organization I Need a Lot of Help Most of the Time	Laundry - Clothes Labeling, sorting, organization I Have Never Tried	Laundry - Clothes Labeling, sorting, organization N/A
Laundry - Folding, hanging, ironing	Laundry - Folding, hanging, ironing Completely Independent	Laundry - Folding, hanging, ironing I Need a Little Bit of Help Sometimes	Laundry - Folding, hanging, ironing I Need a Lot of Help Most of the Time	Laundry - Folding, hanging, ironing I Have Never Tried	Laundry - Folding, hanging, ironing N/A
Money Management - Folding, labeling, organization	Money Management - Folding, labeling, organization Completely Independent	Money Management - Folding, labeling, organization I Need a Little Bit of Help Sometimes	Money Management - Folding, labeling, organization I Need a Lot of Help Most of the Time	Money Management - Folding, labeling, organization I Have Never Tried	Money Management - Folding, labeling, organization N/A
Money Management - Budget, account types	Money Management - Budget, account types Completely Independent	Money Management - Budget, account types I Need a Little Bit of Help Sometimes	Money Management - Budget, account types I Need a Lot of Help Most of the Time	Money Management - Budget, account types I Have Never Tried	Money Management - Budget, account types N/A
Personal Hygiene - Trimming nails, make-up, shaving	Personal Hygiene - Trimming nails, make-up, shaving Completely Independent	Personal Hygiene - Trimming nails, make-up, shaving I Need a Little Bit of Help Sometimes	Personal Hygiene - Trimming nails, make-up, shaving I Need a Lot of Help Most of the Time	Personal Hygiene - Trimming nails, make-up, shaving I Have Never Tried	Personal Hygiene - Trimming nails, make-up, shaving N/A
Career - Resume writing, cover letter	Career - Resume writing, cover letter Completely Independent	Career - Resume writing, cover letter I Need a Little Bit of Help Sometimes	Career - Resume writing, cover letter I Need a Lot of Help Most of the Time	Career - Resume writing, cover letter I Have Never Tried	Career - Resume writing, cover letter N/A
Career - Application completion, Interviewing	Career - Application completion, Interviewing Completely Independent	Career - Application completion, Interviewing I Need a Little Bit of Help Sometimes	Career - Application completion, Interviewing I Need a Lot of Help Most of the Time	Career - Application completion, Interviewing I Have Never Tried	Career - Application completion, Interviewing N/A
ADA Rights and Self-advocacy	ADA Rights and Self-advocacy Completely Independent	ADA Rights and Self-advocacy I Need a Little Bit of Help Sometimes	ADA Rights and Self-advocacy I Need a Lot of Help Most of the Time	ADA Rights and Self-advocacy I Have Never Tried	ADA Rights and Self-advocacy N/A

Completely Independent

I Need a Little Bit of Help Sometimes

I Need a Lot of Help Most of the Time

I Have Never Tried

N/A

Use of large Kitchen Appliances (stove top, oven, grill, etc.)

Use of large Kitchen Appliances (stove top, oven, grill, etc.) Completely Independent

Use of large Kitchen Appliances (stove top, oven, grill, etc.) I Need a Little Bit of Help Sometimes

Use of large Kitchen Appliances (stove top, oven, grill, etc.) I Need a Lot of Help Most of the Time

Use of large Kitchen Appliances (stove top, oven, grill, etc.) I Have Never Tried

Use of large Kitchen Appliances (stove top, oven, grill, etc.) N/A

Use of small Kitchen Appliances (microwave, blender, toaster, etc.)

Use of small Kitchen Appliances (microwave, blender, toaster, etc.) Completely Independent

Use of small Kitchen Appliances (microwave, blender, toaster, etc.) I Need a Little Bit of Help Sometimes

Use of small Kitchen Appliances (microwave, blender, toaster, etc.) I Need a Lot of Help Most of the Time

Use of small Kitchen Appliances (microwave, blender, toaster, etc.) I Have Never Tried

Use of small Kitchen Appliances (microwave, blender, toaster, etc.) N/A

Recipe Use / Meal Planning

Recipe Use / Meal Planning Completely Independent

Recipe Use / Meal Planning I Need a Little Bit of Help Sometimes

Recipe Use / Meal Planning I Need a Lot of Help Most of the Time

Recipe Use / Meal Planning I Have Never Tried

Recipe Use / Meal Planning N/A

Knife Skills - Slice, chop, spread

Knife Skills - Slice, chop, spread Completely Independent

Knife Skills - Slice, chop, spread I Need a Little Bit of Help Sometimes

Knife Skills - Slice, chop, spread I Need a Lot of Help Most of the Time

Knife Skills - Slice, chop, spread I Have Never Tried

Knife Skills - Slice, chop, spread N/A

Eating Etiquette - Scooping, serving, ladle, tongs

Eating Etiquette - Scooping, serving, ladle, tongs Completely Independent

Eating Etiquette - Scooping, serving, ladle, tongs I Need a Little Bit of Help Sometimes

Eating Etiquette - Scooping, serving, ladle, tongs I Need a Lot of Help Most of the Time

Eating Etiquette - Scooping, serving, ladle, tongs I Have Never Tried

Eating Etiquette - Scooping, serving, ladle, tongs N/A

Table Etiquette - Table setting, utensil use

Table Etiquette - Table setting, utensil use Completely Independent

Table Etiquette - Table setting, utensil use I Need a Little Bit of Help Sometimes

Table Etiquette - Table setting, utensil use I Need a Lot of Help Most of the Time

Table Etiquette - Table setting, utensil use I Have Never Tried

Table Etiquette - Table setting, utensil use N/A

Food Safety - Temperatures, sanitation/cleaning

Food Safety - Temperatures, sanitation/cleaning Completely Independent

Food Safety - Temperatures, sanitation/cleaning I Need a Little Bit of Help Sometimes

Food Safety - Temperatures, sanitation/cleaning I Need a Lot of Help Most of the Time

Food Safety - Temperatures, sanitation/cleaning I Have Never Tried

Food Safety - Temperatures, sanitation/cleaning N/A

Trash Disposal & Recycling

Trash Disposal & Recycling Completely Independent

Trash Disposal & Recycling I Need a Little Bit of Help Sometimes

Trash Disposal & Recycling I Need a Lot of Help Most of the Time

Trash Disposal & Recycling I Have Never Tried

Trash Disposal & Recycling N/A

Kitchen Maintenance - Washing dishes, using dishwasher, dish drying

Kitchen Maintenance - Washing dishes, using dishwasher, dish drying Completely Independent

Kitchen Maintenance - Washing dishes, using dishwasher, dish drying I Need a Little Bit of Help Sometimes

Kitchen Maintenance - Washing dishes, using dishwasher, dish drying I Need a Lot of Help Most of the Time

Kitchen Maintenance - Washing dishes, using dishwasher, dish drying I Have Never Tried

Kitchen Maintenance - Washing dishes, using dishwasher, dish drying N/A

Kitchen Management - Labeling, organization, shopping list

Kitchen Management - Labeling, organization, shopping list Completely Independent

Kitchen Management - Labeling, organization, shopping list I Need a Little Bit of Help Sometimes

Kitchen Management - Labeling, organization, shopping list I Need a Lot of Help Most of the Time

Kitchen Management - Labeling, organization, shopping list I Have Never Tried

Kitchen Management - Labeling, organization, shopping list N/A

Home Maintenance - Vacuuming, dusting, sweeping

Home Maintenance - Vacuuming, dusting, sweeping Completely Independent

Home Maintenance - Vacuuming, dusting, sweeping I Need a Little Bit of Help Sometimes

Home Maintenance - Vacuuming, dusting, sweeping I Need a Lot of Help Most of the Time

Home Maintenance - Vacuuming, dusting, sweeping I Have Never Tried

Home Maintenance - Vacuuming, dusting, sweeping N/A

Bed-Making - Fitted sheet, flat sheet, skirt

Bed-Making - Fitted sheet, flat sheet, skirt Completely Independent

Bed-Making - Fitted sheet, flat sheet, skirt I Need a Little Bit of Help Sometimes

Bed-Making - Fitted sheet, flat sheet, skirt I Need a Lot of Help Most of the Time

Bed-Making - Fitted sheet, flat sheet, skirt I Have Never Tried

Bed-Making - Fitted sheet, flat sheet, skirt N/A

Bathroom Maintenance - Cleaning toilets, bathtub, sink; plunger, shower curtain

Bathroom Maintenance - Cleaning toilets, bathtub, sink; plunger, shower curtain Completely Independent

Bathroom Maintenance - Cleaning toilets, bathtub, sink; plunger, shower curtain I Need a Little Bit of Help Sometimes

Bathroom Maintenance - Cleaning toilets, bathtub, sink; plunger, shower curtain I Need a Lot of Help Most of the Time

Bathroom Maintenance - Cleaning toilets, bathtub, sink; plunger, shower curtain I Have Never Tried

Bathroom Maintenance - Cleaning toilets, bathtub, sink; plunger, shower curtain N/A

Laundry - Washing machine and dryer

Laundry - Washing machine and dryer Completely Independent

Laundry - Washing machine and dryer I Need a Little Bit of Help Sometimes

Laundry - Washing machine and dryer I Need a Lot of Help Most of the Time

Laundry - Washing machine and dryer I Have Never Tried

Laundry - Washing machine and dryer N/A

Laundry - Clothes Labeling, sorting, organization

Laundry - Clothes Labeling, sorting, organization Completely Independent

Laundry - Clothes Labeling, sorting, organization I Need a Little Bit of Help Sometimes

Laundry - Clothes Labeling, sorting, organization I Need a Lot of Help Most of the Time

Laundry - Clothes Labeling, sorting, organization I Have Never Tried

Laundry - Clothes Labeling, sorting, organization N/A

Laundry - Folding, hanging, ironing

Laundry - Folding, hanging, ironing Completely Independent

Laundry - Folding, hanging, ironing I Need a Little Bit of Help Sometimes

Laundry - Folding, hanging, ironing I Need a Lot of Help Most of the Time

Laundry - Folding, hanging, ironing I Have Never Tried

Laundry - Folding, hanging, ironing N/A

Money Management - Folding, labeling, organization

Money Management - Folding, labeling, organization Completely Independent

Money Management - Folding, labeling, organization I Need a Little Bit of Help Sometimes

Money Management - Folding, labeling, organization I Need a Lot of Help Most of the Time

Money Management - Folding, labeling, organization I Have Never Tried

Money Management - Folding, labeling, organization N/A

Money Management - Budget, account types

Money Management - Budget, account types Completely Independent

Money Management - Budget, account types I Need a Little Bit of Help Sometimes

Money Management - Budget, account types I Need a Lot of Help Most of the Time

Money Management - Budget, account types I Have Never Tried

Money Management - Budget, account types N/A

Personal Hygiene - Trimming nails, make-up, shaving

Personal Hygiene - Trimming nails, make-up, shaving Completely Independent

Personal Hygiene - Trimming nails, make-up, shaving I Need a Little Bit of Help Sometimes

Personal Hygiene - Trimming nails, make-up, shaving I Need a Lot of Help Most of the Time

Personal Hygiene - Trimming nails, make-up, shaving I Have Never Tried

Personal Hygiene - Trimming nails, make-up, shaving N/A

Career - Resume writing, cover letter

Career - Resume writing, cover letter Completely Independent

Career - Resume writing, cover letter I Need a Little Bit of Help Sometimes

Career - Resume writing, cover letter I Need a Lot of Help Most of the Time

Career - Resume writing, cover letter I Have Never Tried

Career - Resume writing, cover letter N/A

Career - Application completion, Interviewing

Career - Application completion, Interviewing Completely Independent

Career - Application completion, Interviewing I Need a Little Bit of Help Sometimes

Career - Application completion, Interviewing I Need a Lot of Help Most of the Time

Career - Application completion, Interviewing I Have Never Tried

Career - Application completion, Interviewing N/A

ADA Rights and Self-advocacy

ADA Rights and Self-advocacy Completely Independent

ADA Rights and Self-advocacy I Need a Little Bit of Help Sometimes

ADA Rights and Self-advocacy I Need a Lot of Help Most of the Time

ADA Rights and Self-advocacy I Have Never Tried

ADA Rights and Self-advocacy N/A

S.O.A.R. 2023 Teacher of the Visually Impaired Pre-S.O.A.R. Participant Assessment

Question Title

* 1. Please enter your contact information

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* 2. Participant's Name

Question Title

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* 4. Activities of Daily Living Teacher of the Visually Impaired Pre-S.O.A.R. Self-Assessment

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* 5. Comments