PARENT SURVEY/ENGLISH Every 4 years Calif. Dept. of Ed. asks school districts to review program & services provided to students with special needs. Deadline for input is 10/10/12.

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* 1. Child's Primary Exceptionality/Disability (Select only one from drop down)

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* 2. Child's Ethnicity - Is this student Hispanic or Latino? (Select only one)

No, not Hispanic or Latino

Yes, Hispanic or Latino

Intentionally left blank

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* 3. Child's Race - What is this student's race (Select one or more)

American Indian/Alaska Native

Black or African American

White

Asian Indian

Cambodian

Chinese

Filipino

Hmong

Japanese

Korean

Laotioan

Other Asian

Vietnamese

Hawaiian

Guamanian

Samoan

Tahitian

Other Pacific Islander

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* 4. Questions 1 - 5 apply to all parents

	Yes	No	Don't Know
Does the district make a good faith effort to assist your child with achieving the goals and objectives or benchmarks listed in his/her Individualized Education Program (IEP)?	Does the district make a good faith effort to assist your child with achieving the goals and objectives or benchmarks listed in his/her Individualized Education Program (IEP)? Yes	Does the district make a good faith effort to assist your child with achieving the goals and objectives or benchmarks listed in his/her Individualized Education Program (IEP)? No	Does the district make a good faith effort to assist your child with achieving the goals and objectives or benchmarks listed in his/her Individualized Education Program (IEP)? Don't Know
Do you receive progress reports on how your child is meeting his/her Individualized Education Program/Individualized Family Service Plan (IEP/IFSP) goals/outcomes at least as often as the regular report card schedule?	Do you receive progress reports on how your child is meeting his/her Individualized Education Program/Individualized Family Service Plan (IEP/IFSP) goals/outcomes at least as often as the regular report card schedule? Yes	Do you receive progress reports on how your child is meeting his/her Individualized Education Program/Individualized Family Service Plan (IEP/IFSP) goals/outcomes at least as often as the regular report card schedule? No	Do you receive progress reports on how your child is meeting his/her Individualized Education Program/Individualized Family Service Plan (IEP/IFSP) goals/outcomes at least as often as the regular report card schedule? Don't Know
Are the services your child is receiving in acordance with his/her IEP?	Are the services your child is receiving in acordance with his/her IEP? Yes	Are the services your child is receiving in acordance with his/her IEP? No	Are the services your child is receiving in acordance with his/her IEP? Don't Know
Do you receive a copy of your parental rights (procedural safeguards) at least one time per year?	Do you receive a copy of your parental rights (procedural safeguards) at least one time per year? Yes	Do you receive a copy of your parental rights (procedural safeguards) at least one time per year? No	Do you receive a copy of your parental rights (procedural safeguards) at least one time per year? Don't Know
Did the school district facilitate parent involvement as a means of improving services and results for your child?	Did the school district facilitate parent involvement as a means of improving services and results for your child? Yes	Did the school district facilitate parent involvement as a means of improving services and results for your child? No	Did the school district facilitate parent involvement as a means of improving services and results for your child? Don't Know

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* 5. Questions 6 - 7 are for parents of Infants/Toddlers only

	Yes	No	Don't Know
If your child is under three (3) years of age, is his/her Individualized Family Service Plan (IFSP) reviewed with you at least every six (6) months?	If your child is under three (3) years of age, is his/her Individualized Family Service Plan (IFSP) reviewed with you at least every six (6) months? Yes	If your child is under three (3) years of age, is his/her Individualized Family Service Plan (IFSP) reviewed with you at least every six (6) months? No	If your child is under three (3) years of age, is his/her Individualized Family Service Plan (IFSP) reviewed with you at least every six (6) months? Don't Know
Were the transition services for your child from infant to preschool programs planned and implemented as written?	Were the transition services for your child from infant to preschool programs planned and implemented as written? Yes	Were the transition services for your child from infant to preschool programs planned and implemented as written? No	Were the transition services for your child from infant to preschool programs planned and implemented as written? Don't Know

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* 6. Questions 8 - 21 are for parents of School Age children (Preschool through 12th Grade)

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* 7. Questions 22 - 26 are for parents who don't speak English at home or for parents of students who are learning English at school

	Yes	No	Don't Know
Does your child's IEP indicate that he/she is an English Learner?	Does your child's IEP indicate that he/she is an English Learner? Yes	Does your child's IEP indicate that he/she is an English Learner? No	Does your child's IEP indicate that he/she is an English Learner? Don't Know
As an English Learner, does your child receive services to assist with progress in English language development?	As an English Learner, does your child receive services to assist with progress in English language development? Yes	As an English Learner, does your child receive services to assist with progress in English language development? No	As an English Learner, does your child receive services to assist with progress in English language development? Don't Know
As an English Learner, does your child receive the language support in Special Education classes necessary to learn subjects other than English, such as math or science?	As an English Learner, does your child receive the language support in Special Education classes necessary to learn subjects other than English, such as math or science? Yes	As an English Learner, does your child receive the language support in Special Education classes necessary to learn subjects other than English, such as math or science? No	As an English Learner, does your child receive the language support in Special Education classes necessary to learn subjects other than English, such as math or science? Don't Know
If you speak a language other than English, upon request, doyou receive information from the school in your native language?	If you speak a language other than English, upon request, doyou receive information from the school in your native language? Yes	If you speak a language other than English, upon request, doyou receive information from the school in your native language? No	If you speak a language other than English, upon request, doyou receive information from the school in your native language? Don't Know
Upon request, does the district provide a language interpreter for your child's IEP meetings?	Upon request, does the district provide a language interpreter for your child's IEP meetings? Yes	Upon request, does the district provide a language interpreter for your child's IEP meetings? No	Upon request, does the district provide a language interpreter for your child's IEP meetings? Don't Know

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* 8. Do you have any other concerns or information about you or your child's Special Education experience that your would like to tell us?

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* 9. The information below is optional; however, it would be helpful in case we need to follow-up on any of the issues or questions that you may have.

Parent/Guardian:

Child's Name:

Home Address:

Phone Number:

	Yes	No	Don't Know
Do you understand the reasons why your child was referred for Special Education services?	Do you understand the reasons why your child was referred for Special Education services? Yes	Do you understand the reasons why your child was referred for Special Education services? No	Do you understand the reasons why your child was referred for Special Education services? Don't Know
Were your child's strengths considered during the IEP meeting?	Were your child's strengths considered during the IEP meeting? Yes	Were your child's strengths considered during the IEP meeting? No	Were your child's strengths considered during the IEP meeting? Don't Know
Were the results of your child's assessment used to plan IEP goals?	Were the results of your child's assessment used to plan IEP goals? Yes	Were the results of your child's assessment used to plan IEP goals? No	Were the results of your child's assessment used to plan IEP goals? Don't Know
Is your child re-evaluated for Special Education every three (3) years?	Is your child re-evaluated for Special Education every three (3) years? Yes	Is your child re-evaluated for Special Education every three (3) years? No	Is your child re-evaluated for Special Education every three (3) years? Don't Know
Does the district have an IEP meeting for your child at least once a year?	Does the district have an IEP meeting for your child at least once a year? Yes	Does the district have an IEP meeting for your child at least once a year? No	Does the district have an IEP meeting for your child at least once a year? Don't Know
Does a regular education teacher attend your child's IEP meeting, unless you and the district agree, under specified circumstances, to excuse him/her?	Does a regular education teacher attend your child's IEP meeting, unless you and the district agree, under specified circumstances, to excuse him/her? Yes	Does a regular education teacher attend your child's IEP meeting, unless you and the district agree, under specified circumstances, to excuse him/her? No	Does a regular education teacher attend your child's IEP meeting, unless you and the district agree, under specified circumstances, to excuse him/her? Don't Know
Were information and any concerns you had about your child considered when planning and writing his/her IEP?	Were information and any concerns you had about your child considered when planning and writing his/her IEP? Yes	Were information and any concerns you had about your child considered when planning and writing his/her IEP? No	Were information and any concerns you had about your child considered when planning and writing his/her IEP? Don't Know
At your child's meeting, did the team discuss your child's program in terms of the least restrictive environment (e.g., general education classroom, resource, special day class, etc.) for him/her?	At your child's meeting, did the team discuss your child's program in terms of the least restrictive environment (e.g., general education classroom, resource, special day class, etc.) for him/her? Yes	At your child's meeting, did the team discuss your child's program in terms of the least restrictive environment (e.g., general education classroom, resource, special day class, etc.) for him/her? No	At your child's meeting, did the team discuss your child's program in terms of the least restrictive environment (e.g., general education classroom, resource, special day class, etc.) for him/her? Don't Know
Are teachers and service providers informed of specific responsibilities related to implementing your child's IEP and the specific accommodations, program modifications and support for school personnel?	Are teachers and service providers informed of specific responsibilities related to implementing your child's IEP and the specific accommodations, program modifications and support for school personnel? Yes	Are teachers and service providers informed of specific responsibilities related to implementing your child's IEP and the specific accommodations, program modifications and support for school personnel? No	Are teachers and service providers informed of specific responsibilities related to implementing your child's IEP and the specific accommodations, program modifications and support for school personnel? Don't Know
Did you discuss a variety of program options for your child at the IEP meeting?	Did you discuss a variety of program options for your child at the IEP meeting? Yes	Did you discuss a variety of program options for your child at the IEP meeting? No	Did you discuss a variety of program options for your child at the IEP meeting? Don't Know
Are IEP goals and objectives reviewed and revised at the IEP meeting, based on both progress and lack of progress?	Are IEP goals and objectives reviewed and revised at the IEP meeting, based on both progress and lack of progress? Yes	Are IEP goals and objectives reviewed and revised at the IEP meeting, based on both progress and lack of progress? No	Are IEP goals and objectives reviewed and revised at the IEP meeting, based on both progress and lack of progress? Don't Know
Does your child have the opportunity to participate in school and extra curricular activites (such as, assemblies, field trips and after school activities)?	Does your child have the opportunity to participate in school and extra curricular activites (such as, assemblies, field trips and after school activities)? Yes	Does your child have the opportunity to participate in school and extra curricular activites (such as, assemblies, field trips and after school activities)? No	Does your child have the opportunity to participate in school and extra curricular activites (such as, assemblies, field trips and after school activities)? Don't Know
Did the IEp team discuss how your child would participate in State and district testing?	Did the IEp team discuss how your child would participate in State and district testing? Yes	Did the IEp team discuss how your child would participate in State and district testing? No	Did the IEp team discuss how your child would participate in State and district testing? Don't Know
If your child will turn 16 years of age before his/her next IEP meeting, did the IEP team discuss transition services (e.g., career interest, employment, high school classes) at the most recent meeting?	If your child will turn 16 years of age before his/her next IEP meeting, did the IEP team discuss transition services (e.g., career interest, employment, high school classes) at the most recent meeting? Yes	If your child will turn 16 years of age before his/her next IEP meeting, did the IEP team discuss transition services (e.g., career interest, employment, high school classes) at the most recent meeting? No	If your child will turn 16 years of age before his/her next IEP meeting, did the IEP team discuss transition services (e.g., career interest, employment, high school classes) at the most recent meeting? Don't Know