PARENT/GUARDIAN TRANSITION QUESTIONNAIRE
LIFESKILLS TRANSITION PLANNING
Student Name _______________________________________ Date ______________________________
Telephone Number ___________________________________ Expected Year of Graduation ____________
For the school to work with you and other agencies in getting your child ready for the world of work, the following information
would be helpful for transition planning:
Other agencies involved with your daughter/son either currently or projected after graduation_______________
______________________________________________________________________________________
I. Vocational Needs
1. When she/he graduates from the public school, we would like our daughter/son to participate in:
____ Day Care/Activity Program
____ Sheltered Workshop
____ Supported Part-time Employment
____ Supported Full-time
____ Competitive Part-time
____ Competitive Full-time
____ Other (Specify) _________________________________________________________
2. In which kind of job(s) does you daughter/son seem interested? _____________________________
________________________________________________________________________________
3. What kinds of jobs does she/he like? _________________________________________________
________________________________________________________________________________
4. Do you have a preference for occupational placement?_____________________________________
5. Are there jobs in which you object to your daughter/son’s placement? If so, what? ______________
________________________________________________________________________________
6. If there are any medical concerns relating to your daughter/son/s vocational placement?
________________________________________________________________________________
7. What skills to you think need to be developed to help you daughter/son reach her/his vocational goals?
________________________________________________________________________________
II. Community Living (Please check one from the list)
____ Live independently in an apartment or home
____ With family member (who?) _____________________
____ With support
____ Other, please describe
____ Supervised apartment
___ Group home
______________________________________________________________________________________
III. Recreational and Leisure Options
A. Leisure Interest Inventory
Check all of the following leisure activities in which your son or daughter currently spends free time:
_____ Swimming
_____ Lifting weights
_____ Running
______Fishing
_____ Softball
_____ Basketball
_____ Skiing (winter sports)
_______Camping
_____ Riding motorcycle
Attends Large Group Events
____ movies
____ ball games
____ music events
____ school dances
Individual Activities
____ handcrafts
____ listening music
____ caring for pets
____ talking on phone
____ watching TV
____ playing cards or board games
____ dating
____ picnic
____ dancing
____ eating out
____ spending time with family or friends
Participates in Social Activities
____ attending church ____ other _______________________________________________
IV. Transportation Options
How will you daughter or son get around the community and to work?
drive own vehicle
Does Now
________
Needs to Learn
----------
use SEPTA bus transportation
________
----------
ride a bicycle
________
----------
walk
________
----------
use special transportation system ________
----------
depend on others
________
----------
Are you willing to drive your daughter or son to work? ____ Yes
____ No
V. Financial Support
A. Does your daughter or son need financial assistance in any of the following areas to reach her or his
long-range goals?
1. Post-Secondary education
____ Yes ____ No
If yes, please check all of the following for which you would like additional information.
____ Office of Vocational Rehabilitation
____ BARC
____ Supplemental Security Income (SSI)
____ Social Security Disability Insurance (SSDI)
2. Employment Assistance
____ Yes ____ No
If yes, please check all of the following for which you would like additional information.
____ Office of Vocational Rehabilitation
____ AHEDD
____ Associated Production Services
____ MH/DP
3. Home living assistance
____ Yes ____ No
If yes, please check all of the following for which you would like additional information.
____ County social services
____ Housing assistance
____ Independent living centers
____ Community Options
VI. Health-Related Needs
A. Does your child currently have any of the following needs?
____ medical (i.e., medications)
____ yes*
____ no
____ counseling
____ yes*
____ no
* Please explain ___________________________________________________________________
_______________________________________________________________________________
B. Currently, what is your greatest future concern for you daughter or son?______________________
________________________________________________________________________________
________________________________________________________________________________