Student's Name

Parent's Name

1. If your child has talked about working, what types of jobs have he/she shown interest in doing when he/she is grown up?

2. What kinds of things does your child like to do in their free time?

3. What does your child like to talk about when he/she is home?

4. Does your child have friends that he/she participates with on a daily or weekly basis?
YesNo

If “YES,” what types of activities does your child and their friends usually do?

5. What does your child do to help out at home with the daily or weekly tasks?

6. What kinds of activities does your child participate in outside of the home for entertainment?

7. What would you like for the school to know about your child?

8. What are your future work expectations for your child after he/she graduates from high school?

9. What are your future expectations for your child on where he/she will live after graduation? (For example: Our home, on their own, group home, with friends, etc.)

10. What are your concerns about what the school needs to do for your child?

11. Which of these independent living skills do you think your child needs instruction in? Check all that you believe are your concerns.
Buying and caring for clothingHygiene and groomingHow to be a good parentHow to buy things wiselyMoney management skillsSex education knowledgeMeal preparation and nutritionUsing public transportationGetting their driver’s licenseKnow what is in the communityHow to be safe in the communityHealth and First Aide trainingOther

Other areas of concern: