Career Development Program
Parent/Guardian
Transition Planning Survey
For Students Needing Ongoing Post
Secondary Supports
Updated June 2010
Student: ______________________________________
School: _______________________________________
Date Completed: ________________________________
Date Updated: _________________________________
Date Updated: _________________________________
Date Updated: __________________________________
Career Development Program 2010
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Allegheny Intermediate Unit Disclaimer This document contains privileged and/or confidential information intended
only for the person or entity to which it is addressed. Any unauthorized or improper disclosure, copying, distribution,
or use of the contents of this document is prohibited.
Career Development Program 2010
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Greetings Parents and Guardians:
Transition is the process of preparing students for life after they leave high school including successful
participation in post-secondary education or training, employment, and community living. These three areas are
the “Post-School Goals” in your child’s Individualized Education Program (IEP).
Over the secondary Transition years of 14 through the age of graduation your child will mature and continue to
develop skills. Through continued discussions and planning with your child and the IEP team you will see
changes in your child which may cause you to reconsider your hopes and dreams for him or her. Take a moment
to think about the journey into adulthood and complete the Parent Survey on the next few pages. Return it to me
in the enclosed envelope.
Please complete this Parent Survey and return it to me in the enclosed envelope. Your son or daughter will have
similar input through various transition activities here at _________________________ School. This
information is an essential step in the Transition IEP process.
Thank you,
Career Development Program 2010
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POST-SECONDARY EDUCATION/TRAINING And EMPLOYMENT
Student Name: _______________________________________________________________________________
Grade: _______________
Birth date: __________________
Date of Survey: __________________
Address: _____________________________________________________
_____________________________________________________
Phone No.: ________________________
Expected Date of Graduation: ________________
Parent/Guardian:________________________________________________________________________________________
Name of Person Completing the Survey: _______________________________________________________________
Relationship to Student: _______________________________________________________________
Following graduation, I would like my child to pursue further education/training:
_____ yes _____ no
If yes, please indicate the type(s) of post-secondary education/training that will benefit your child:
_____ on-the-job training in the community at employer site
with support such as 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
focusing on daily living skills instruction and practice
_____ activity program focusing on socialization and community integration activities
_____ other (please describe) ________________________________________________
Following graduation, I would like my child to pursue employment:
_____ yes _____ no
If yes, please indicate the type(s) of employment you believe will benefit your child:
_____ 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 per week
_____ other (please describe) ______________________________________________

Describe your child’s interests and abilities related to future education/training and employment
opportunities.
____________________________________________________________________________
____________________________________________________________________________
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
List post-secondary programs or sites that you have visited or have an interest.
____________________________________________________________________________

Describe characteristics you are seeking in your child’s future education/training and
employment program. ___________________________________________________________
List medical concerns related to your child’s future education/training and employment.
____________________________________________________________________________
DAILY LIVING:
Following graduation, where do you anticipate your child will reside?
______ in minimally supervised residence with some assistance/roommates
______ in 24 hour supervised residence with maximum assistance
______ at home with parents/guardians/family
______Other (specify): ____________________________________
List responsibilities/chores your child completes at home presently.
_________________________________________________________________________________
_________________________________________________________________________________
List daily living skills you would like your child to learn or improve.
_________________________________________________________________________________
_________________________________________________________________________________
TRANSPORTATION:
Following graduation, which type(s) of transportation do you anticipate your child will use?
_______ walk or ride bicycle independently
_______ use public transportation such as bus/trolley independently
_______ use ACCESS paratransit independently
_______ get rides from family/friends
_______ get rides from private agency
_______ other (specify): ____________________________________
COMMUNITY PARTICIPATION:
Has your child:
_____ obtained photo ID card (age 16)
_____ registered to vote (age 18)
_____ acquire ½ price fare card for public
transportation
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_____ applied for ACCESS paratransit
_____ registered for selective service
(mandatory for males age 18)
RECREATION/LEISURE:
List recreation/leisure activities your child enjoys on a regular basis.
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
List any recreation/leisure activities you would like more information about.
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
AGENCY PARTICIPATION:
Does your child receive Social Security benefits? ____ yes ____ no
Is your child registered with your county’s office of Mental Retardation/Developmental
Disabilities (MR/DD)? ____ yes ____ no
If registered, indicate which Supports Coordination Organization (SCO).
_____Mon Valley Supports Coordination Unit
_____Staunton Clinic
_____Family Links
_____WPIC Independent Supports Coordination of UPMC
_____Other (please specify):___________________________________
If registered, name the Supports Coordinator (SC) assigned to your child.
Supports Coordinator (SC) Name:____________________________________
Does your child receive Mental Health (MH) services? ____ yes ____ no
If yes, list agency name(s) and type(s) of services:
_____________________________________________________________________
_____________________________________________________________________
Allegheny Intermediate Unit
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ADDITIONAL INFORMATION:
Please list additional concerns/questions/information not included in this survey that you have regarding
your child’s transition into the adult world.
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
***The information you have provided in this survey will be used in the IEP and supports your child’s future. As a parent, you are a
member of your child’s IEP team, and we, the Local Education Agency (LEA) want you to attend the IEP meeting. During the IEP
years there will be opportunities to invite agencies that may support your child in their adult years. Please consider signing this statement
to give your permission to invite outside agencies such as OVR, MR/DD, MH, health agencies and others that might assist your son/
daughter in their future.
You will be notified of agencies that the IEP team feels may contribute support in the future and can let the team know you do not want
them invited at any time.
_________________________________________________________
Signature
Allegheny Intermediate Unit
Date
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