Needs Assessment Survey

Part 1. Demographics

The law requires that certain information be gathered about those taking the survey for the purpose of data analysis and for the possible audit of our needs assessment procedure. All respondents will remain anonymous, and individual responses will be treated confidentially.

A. Which of the following describes your role? *

If other, please specify: *

B. Please check the school district(s) in which you work or the school district in which your child attends school: *

C. Please check the age range(s) below of children with disabilities you serve or the age range that best describes your child: *

D. Please select the type of school in which you serve or the school that your child attends: *

Three types of needs are being assessed:

Unserved Needs: Needs of children with disabilities who are receiving no educational services at present.
Underserved Needs: Needs of children with disabilities, currently in school, who require additional services.
In-Service/Personnel Development: Needs of teachers and administrators who serve children with disabilities.

Part 2. Unserved Needs

If you are not aware of any children with disabilities in your area who have been completely overlooked, check the next statement and go Part 3.

I am not aware of any unserved children with a disability.

If you know of unserved children with disabilities in the JAMP Special Education Services districts, please check the appropriate box(es) to indicate the type of disability and age range of the unserved child/children.

Birth - 3

Age 4 - 5

Age 6 - 14

Age 15 - 21

Autism *

Birth→3

Age 4→5

Age 6→14

Age 15→21

Mental Retardation *

Birth→3

Age 4→5

Age 6→14

Age 15→21

Learning Disability *

Birth→3

Age 4→5

Age 6→14

Age 15→21

Orthopedic Impairment *

Birth→3

Age 4→5

Age 6→14

Age 15→21

Vision/Blindness *

Birth→3

Age 4→5

Age 6→14

Age 15→21

Hearing/Deafness *

Birth→3

Age 4→5

Age 6→14

Age 15→21

Speech/Language *

Birth→3

Age 4→5

Age 6→14

Age 15→21

Multiple Disabilities *

Birth→3

Age 4→5

Age 6→14

Age 15→21

Emotional Disturbance *

Birth→3

Age 4→5

Age 6→14

Age 15→21

Developmental Delay *

Birth→3

Age 4→5

Age 6→14

Age 15→21

Other Health Impairment *

Birth→3

Age 4→5

Age 6→14

Age 15→21

Traumatic Brain Injury *

Birth→3

Age 4→5

Age 6→14

Age 15→21

Other

Birth→3

Age 4→5

Age 6→14

Age 15→21

If other, please specify: *

Comments: *

Part 3. Needs of Underserved Children with Disabilities, ages 3-21

If you feel the current program needs no additional emphasis, go part 4.

To the best of my knowledge, the program needs no added emphasis.

Please use the scale below if you believe additional emphasis is needed.

No Option

No Added Emphasis:

Moderate Emphasis Needed:

High Emphasis Needed:

Speech & Language Services *

No Opinion:

No Added Emphasis:

Moderate Emphasis Needed:

High Emphasis Needed:

Psychological Services *

No Opinion:

No Added Emphasis:

Moderate Emphasis Needed:

High Emphasis Needed:

Physical Therapy *

No Opinion:

No Added Emphasis:

Moderate Emphasis Needed:

High Emphasis Needed:

Occupational Therapy *

No Opinion:

No Added Emphasis:

Moderate Emphasis Needed:

High Emphasis Needed:

School Social Work Services Regular Education *

No Opinion:

No Added Emphasis:

Moderate Emphasis Needed:

High Emphasis Needed:

Program Supervision *

No Opinion:

No Added Emphasis:

Moderate Emphasis Needed:

High Emphasis Needed:

School Social Work Services Special Education *

No Opinion:

No Added Emphasis:

Moderate Emphasis Needed:

High Emphasis Needed:

Counseling Services *

No Opinion:

No Added Emphasis:

Moderate Emphasis Needed:

High Emphasis Needed:

Pre-Vocational Education *

No Opinion:

No Added Emphasis:

Moderate Emphasis Needed:

High Emphasis Needed:

Adaptive Physical Education *

No Opinion:

No Added Emphasis:

Moderate Emphasis Needed:

High Emphasis Needed:

Transition *

No Opinion:

No Added Emphasis:

Moderate Emphasis Needed:

High Emphasis Needed:

Residential Services (24 Hour Care) *

No Opinion:

No Added Emphasis:

Moderate Emphasis Needed:

High Emphasis Needed:

Extended School Year (Summer) *

No Opinion:

No Added Emphasis:

Moderate Emphasis Needed:

High Emphasis Needed:

Behavioral Management Intervention *

No Opinion:

No Added Emphasis:

Moderate Emphasis Needed:

High Emphasis Needed:

Instructional Services *

No Opinion:

No Added Emphasis:

Moderate Emphasis Needed:

High Emphasis Needed:

Other

No Opinion:

No Added Emphasis:

Moderate Emphasis Needed:

High Emphasis Needed:

If other, please specify: *

Comments

Part 4. In-Service/Personnel Development.

Please rate the additional emphasis needed in the following in-service/personnel development categories:

No Added Emphasis:

Moderate Emphasis Needed:

High Emphasis Needed:

NCLB High Qualified *

No Added Emphasis:

Moderate Emphasis Needed:

High Emphasis Needed:

Childhood Syndromes/Educational Impact *

No Added Emphasis:

Moderate Emphasis Needed:

High Emphasis Needed:

Curriculum Development *

No Added Emphasis:

Moderate Emphasis Needed:

High Emphasis Needed:

Section 504 of the Rehabilitation Act *

No Added Emphasis:

Moderate Emphasis Needed:

High Emphasis Needed:

Referral Process *

No Added Emphasis:

Moderate Emphasis Needed:

High Emphasis Needed:

Recertification *

No Added Emphasis:

Moderate Emphasis Needed:

High Emphasis Needed:

Parent Involvement *

No Added Emphasis:

Moderate Emphasis Needed:

High Emphasis Needed:

Mental Illness/Educational Impact *

No Added Emphasis:

Moderate Emphasis Needed:

High Emphasis Needed:

Suicide Prevention *

No Added Emphasis:

Moderate Emphasis Needed:

High Emphasis Needed:

Attention Deficit Hyperactive Disorder *

No Added Emphasis:

Moderate Emphasis Needed:

High Emphasis Needed:

No Child Left Behind *

No Added Emphasis:

Moderate Emphasis Needed:

High Emphasis Needed:

Positive Behavioral Interventions & Supports (PBIS) *

No Added Emphasis:

Moderate Emphasis Needed:

High Emphasis Needed:

Autism *

No Added Emphasis:

Moderate Emphasis Needed:

High Emphasis Needed:

Crisis Prevention Strategies (Physical Restraint) *

No Added Emphasis:

Moderate Emphasis Needed:

High Emphasis Needed:

Special Education Law *

No Added Emphasis:

Moderate Emphasis Needed:

High Emphasis Needed:

→ State Regulations *

No Added Emphasis:

Moderate Emphasis Needed:

High Emphasis Needed:

→ IDEA Reauthorization *

No Added Emphasis:

Moderate Emphasis Needed:

High Emphasis Needed:

Birth-3 Programming/Transition *

No Added Emphasis:

Moderate Emphasis Needed:

High Emphasis Needed:

Rtl Problem Solving Model *

No Added Emphasis:

Moderate Emphasis Needed:

High Emphasis Needed:

AimsWeb *

No Added Emphasis:

Moderate Emphasis Needed:

High Emphasis Needed:

Behavior Management *

No Added Emphasis:

Moderate Emphasis Needed:

High Emphasis Needed:

IEP Writing *

No Added Emphasis:

Moderate Emphasis Needed:

High Emphasis Needed:

Secondary Transition *

No Added Emphasis:

Moderate Emphasis Needed:

High Emphasis Needed:

Secondary Rtl *

No Added Emphasis:

Moderate Emphasis Needed:

High Emphasis Needed:

Progress Monitoring *

No Added Emphasis:

Moderate Emphasis Needed:

High Emphasis Needed:

Rtl Interventions *

No Added Emphasis:

Moderate Emphasis Needed:

High Emphasis Needed:

CPI Training *

No Added Emphasis:

Moderate Emphasis Needed:

High Emphasis Needed:

Other

No Added Emphasis:

Moderate Emphasis Needed:

High Emphasis Needed:

If other, please specify: *

Comments:

Educator Resources

Who we are

Our Mission

Part 1. Demographics

Part 2. Unserved Needs

Part 3. Needs of Underserved Children with Disabilities, ages 3-21

Part 4. In-Service/Personnel Development.