This survey is for parents of deaf/hard of hearing children who receive services from an itinerant teacher of the deaf. An itinerant teacher of the deaf is one who usually travels from school to school seeing several DHH students.

* 1. How old is your child?

* 2. The town/city where my child attends school has: 

* 3. How old was your child when he/she was diagnosed with a hearing loss?

* 4. What is the degree of your child's hearing loss?

* 5. Is your child's hearing loss unilateral or bilateral?

* 6. What type of listening device does your child use? (check all that apply)

* 7. Is the listening device worn full time or part time?

* 8. What is the preferred method of communication at home?

* 9. Is there anyone else in the home who is Deaf or Hard-of-Hearing?

* 10. Does your child have another disability in addition to hearing loss?

* 11. If yes, what is the disability? (check all that apply) If no, click to the next question.

* 12. What type of school does your child attend?

* 13. How many years has your child received services from an Itinerant Teacher of the Deaf?

* 14. How far does the Itinerant Teacher of the Deaf travel to see your child?

* 15. How often does your child meet with the  Itinerant Teacher of the Deaf?

* 16. How often do you communicate with the Itinerant Teacher of the Deaf?

* 17. How often does the  Itinerant Teacher of the Deaf communicate your child's progress to you?

* 18. Are the services provided by the  Itinerant Teacher of the Deaf  for your child:

* 19. Rate your satisfaction with the amount of visits your child receives from an  Itinerant Teacher of the Deaf.

* 20. Rate your satisfaction with the feedback you receive from the  Itinerant Teacher of the Deaf.

* 21. Rate your satisfaction with the amount of time during visits your child spends with the Itinerant Teacher of the Deaf.

* 22. Rate your satisfaction with the one-on-one help your child receives from an Itinerant Teacher of the Deaf.

* 23. Rate your satisfaction with how the Itinerant Teacher of the Deaf communicates with the regular education teacher about your child's needs.

* 24. Rate your satisfaction with the accessibility of the Itinerant Teacher of the Deaf.

* 25. Rate your satisfaction with how the Itinerant Teacher of the Deaf assists your child in developing speech skills.

* 26. Rate your satisfaction with how the Itinerant Teacher of the Deaf assists your child in developing listening skills.

* 27. Rate your satisfaction with how the Itinerant Teacher of the Deaf assists your child in developing language and literacy skills.

* 28. Rate your satisfaction with how the Itinerant Teacher of the Deaf assists your child with hearing aids, cochlear implants, and FM systems.

* 29. Rate your satisfaction with how the Itinerant Teacher of the Deaf supports your child's chosen mode of communication.

* 30. Rate your satisfaction with how the Itinerant Teacher of the Deaf supports your child's self-advocacy skills and independence.

* 31. Rate your satisfaction with how the Itinerant Teacher of the Deaf explains hearing loss to principals, teachers, and other staff.

* 32. Rate your satisfaction with how the Itinerant Teacher of the Deaf supports your child's educational assistant.

* 33. Rate your satisfaction with how the Itinerant Teacher of the Deaf supports your child's educational interpreter.

* 34. List your recommendations for improving Itinerant Teacher of the Deaf services for children who are Deaf and Hard-of-Hearing.

* 35. Is there anything else you want to share?

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