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Educator Special Education Survey

1. Part One

This year, your school district had an MPACT mentor participate in the special education process. Completion of this survey will help us evaluate the effectiveness of MPACT's mentor program. The completed survey will come directly to MPACT, and the results are entered into our survey database. Please take a moment to answer the brief survey below about your experience with this program.

MPACT takes your privacy very seriously; personal information will not be shared with anyone outside of MPACT. Please be aware that a summary of our survey results are reported to DESE on a semi-annual basis. If you do not include your contact information, your survey will not be included in our report to DESE; therefore, please provide your name and at least one method of contact.

Question Title

* Please fill in your contact information in the space below. Items with an * must be completed to proceed to next section.

*Name:

Your Position:

Address:

City/Town:

State:

Zip Code:

*Email Address:

*Phone Number:

Question Title

* Fill in the information below. All fields must be answered to proceed to the next section.

Name of Parent Mentor:

Date of Meeting (mm/dd/yyyy):

Meeting Type:

School:

School District:

School District County:

School District Zip Code:

50% of survey complete.