Career Development Program
Student Transition Planning Survey
Updated June 2010
Student: _____________________________________
School: ______________________________________
Date Completed:______________________________
Date Updated: _______________________________
Date Updated: _______________________________
Date Updated: _______________________________
The Allegheny Intermediate Unit is an equal opportunity education institution and will not discriminate on the basis of race, color,
national origin, ancestry, religion, sex, sexual orientation, age, handicap or limited English proficiency in its educational programs,
services, facilities, activities or employment practices, as required by Title IX of the 1972 Educational Amendments, Titles VI and VII of
the Civil Rights of 1964 as amended, Section 504 Regulations of the Rehabilitation Act of 1973, the Age Discrimination in Employment
Act of 1975, Section 204 Regulations of 1984 Carl D. Perkins Act, the Americans With Disabilities Act, or any other applicable federal or
state statute.
Career Development Program 2010
Student Transition Survey
Name: _____________________________________________________ Date: _____________
DOB: ________________ Grade: _________ Age:________ Graduation Year: ________
Contact Teacher: ______________________________________________________________
SCHOOL
1. What is your favorite subject in school? _______________________________________
Why? _______________________________________________________________________
2. What is your least favorite subject in school? _________________________________
Why? _______________________________________________________________________
3. What is your easiest subject in school? _______________________________________
4. What is your most difficult subject in school? _________________________________
5. What electives have you taken?
a. _____________________________________________
liked/disliked
b. _____________________________________________
liked/disliked
c. _____________________________________________
liked/disliked
d. _____________________________________________
liked/disliked
e. _____________________________________________
liked/disliked
f. ______________________________________________
liked/disliked
6. What other electives would like to take while still in high school?
a. _______________________________________________
b. _______________________________________________
c. _______________________________________________
d. _______________________________________________
7. In what school clubs, sports, or activities do you participate?
a. _______________________________________________
b. _______________________________________________
c. _______________________________________________
d. _______________________________________________
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8. Are you interested in a visit to the local career and technical center?
YES NO
9. If your answer to # 8 is YES, in which program are you interested?
____________________________________________________________________
WORK EXPERIENCE
10. Have you had any paid work experience?
YES NO
11. If your answer to #10 is YES, please list your paid work experiences below.
a. _______________________________________________
b. _______________________________________________
c. _______________________________________________
d. _______________________________________________
12. Have you had any volunteer work experience or done any community service?
YES NO
13. If your answer to #12 is YES, please list your volunteer work/community
service experiences below.
a. _______________________________________________
b. _______________________________________________
c. _______________________________________________
d. _______________________________________________
14. What is your work preference? Please circle.
Physical Work
Desk Work
Inside Work
Outside Work
Working Alone
Working with Others
Repetitive Tasks
Varied Tasks
POST-SCHOOL PLANS
15. What are your plans after graduating from high school?
______ Post-secondary Education/Training
______ Competitive Employment
______ Military
______ Unsure
POST-SECONDARY EDUCATION / TRAINING
16. What type of post-secondary school would you like to attend?
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______ Community College ______ Four-Year School ______ Technical School ______ Union
apprenticeship ______Trade School
______ On-the-job Training
______Other (please name)
(go to QUESTION #21) ___________________
17. What career area would like to study? _____________________________________
18. Do you think that you will need supportive services while attending a post-secondary
school? YES NO
19. Where do you plan to live while attending a post-secondary school?
_____ At school
(dormitory, apartment, etc.)
_____ With family or friends
_____ Other: (be specific) ____________________________________________
20. Do you plan to work while attending post-secondary school?
_______ Full time
YES
NO
_______ Part-time
(Go to QUESTION #26)
EMPLOYMENT
21. What career area do you plan to pursue after graduating from high school?
________________________________________________________________________________
22. Do you plan to work part-time or full-time? __________________________________
23. When employed, what will our living arrangements be?
____ With family ____ With friends ____ Independently ____ Other (explain)
________________________________________________________________________________
24. Do you plan to join the military after graduating from high school?
YES
NO
25. If your answer to question #28 is YES, what branch of the military are you interested
enlisting in? _________________________________________________________
RECREATION/LEISURE
26. What leisure activities (free time) do you enjoy? ______________________________
________________________________________________________________________________
27. Do you take any classes outside of school (music, dance, etc.)? YES
NO
If your answer is YES, list the classes. __________________________________________
________________________________________________________________________________
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28. Are you involved in any community activities?
YES
NO
If your answer is YES, please list the activities. __________________________________
________________________________________________________________________________
TRANSPORTATION
29. What type of transportation will you use to go to and from school and/or work?
____ Drive yourself ____ Public Transportation _____ Parent/friend/carpool
____ Other (explain) ____________________________________________________________
30. Do you have your Learner’s Permit or Driver’s License?
YES
NO
If YES write the one that you have. ______________________________________________
31. Do you plan to use public transportation after high school graduation?
YES
NO
If your answer to question #32 is NO, what other form of transportation is available to you?
________________________________________________________________________
SELF – ADVOCACY
32. What goal would you like to accomplish in the next year? ____________________
________________________________________________________________________________
33. What goal would you like to accomplish one year after completing high school?
________________________________________________________________________________
34. What goal would you like to accomplish five years after completing high school?
_______________________________________________________________________
________________________________________________________________________________
35. Do you know what an IEP is?
YES
36. Can you explain why you have an IEP?
NO
YES
NO
Explain: _______________________________________________________________________
_______________________________________________________________________________
________________________________________________________________________________
37. Have you attended your IEP meetings?
YES
NO
38. Do you feel that you have been an active part of your IEP team?
YES
NO
39. What do you think is your greatest strength?
________________________________________________________________________________
________________________________________________________________________________
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40. What do you think is a skill that you need to improve?
____________________________________________________________________
____________________________________________________________________
41. What do you feel that you need to help you be successful after graduation from high
school? ___________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
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