2021-2022 Form: Parent Transition Survey (only complete if your child is 13+)

Student Name*

Answer Required

Following graduation, I would like my child to pursue futher education/training.*

Answer Required

Yes

If yes, please indicate the type(s) of post-secondary education/training that will benefit your child.

Answer Required

on the job training in the community at employer site

with support of a job coach

vocational training program in a supervised facility

with other peers with disabilities such as in a workshop

training program in supervised facility

focus on daily living skills instruction and practice

Following graduation, I would like my child to pursue employment.*

Answer Required

Yes

If yes, please indicate the type(s) of employment you believe will benefit your child.

Answer Required

employment within a small supervised group in the community such as a cleaning crew

employment with other peers with disabilities in a supervised facility such as an assembly line workshop

individualized employment in a supervised facility such as shredding paper a few hours a week

Other:

Describe your child's interests and abilities related to future education/training and employment opportunities.*

Answer Required

List post-secondary programs sites that you have visited or have an interest in visiting.*

Answer Required

Describe characteristics you are seeking in your child's future education/training and employment program.*

Answer Required

List medical concerns related to your child's future education/training and employment.*

Answer Required

Following graduation, where do you anticipate your child will reside?*

Answer Required

in a minimally supervised residence with some assistance/roommates

in a 24-hour supervised residence with maximum assistance

at home with parents/guardians/family

Other:

List responsibilities/chores your child completes at home presently.*

Answer Required

List daily living skills you would like your child to learn or improve.*

Answer Required

Following graduation, which type(s) of transportation do you anticipate your child will use?*

Answer Required

walk or ride a bike independently

use public transportation independently

transportation provided by family

Other:

Does your child have any of the following or applied for any of the following?*

Answer Required

photo ID card (age 16)

registered to vote (age 18)

discounted bus fare card

registered for selective service (mandatory for males age 18)

None

Are you or your child involved with any of the following agencies?*

Answer Required

OVR

Beaver County Behavioral Health

Achieva

Other

None

If your child is involved with an agency, please enter the name of his/her caseworker.

Answer Required

Please fix the highlighted areas below before submitting.

2021-2022 Form: Parent Transition Survey (only complete if your child is 13+)