| Your Name |
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Address & Zip code |
Street
Town
+4
Zip
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| Telephone |
|
|
E-mail
|
@
|
School |
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| Grade |
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| |
What is your child's disability?
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| |
What Services does your child receive?
Speech Language
Resource Room
Counseling
PE
OT
Self-contained classroom
BOCES
Other:
|
| 1.) |
What would you like to see the PAC doing that would be of benefit
to you and your family? i.e., Training, Support, Speakers,
Workshops, etc.
|
| 2.) |
What topics would you like us to cover?
|
| 3.) |
Do you want information on a particular disability? i.e., Autism,
Cerebral Palsy, Attention Deficit / Attention Deficit Hyperactivity
Disorder, Learning Disability, Dyslexia, Mental Retardation, etc.
|
| 4.) |
Would you be willing to represent your child's school as a resource
for other special education needs parents within the school? (Parent
training may be provided)
Yes No
|
| 5.) |
Would you be willing to represent PAC at your schools PTA and
other school committee/board meetings?
Yes
No
|
| 6.) |
Do you have any concerns or questions about your child's Individualized
Education Plan (IEP)?
|
| 7.) |
Concerns or questions about your child's placement or school?
|
| 8.) |
Concerns or questions about your child's curriculum or progress?
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| 9.) |
Concerns or questions about training?
|
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10.)
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Would you like a member of the PAC Chair to contact you about
your concerns?
If so
Telephone
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| 11.) |
How often do you go into your child's school during the year?
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| 12.) |
Will you return for other PAC meeting?
Yes
No
Maybe
|
| 13.) |
Do you have any suggestions how we can encourage other parents
to attend?
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