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 Post-School Survey







 Legal Guardian


elationship to graduate:



Graduate's Name:


School graduated from and date of graduation:

Sex: Male  Female



Ethnic Origin

 Black Non-Hispanic

 White Non-Hispanic

 American Indian


 Asian/Pacific Islander



1. Graduate's disability

(Check appropriate boxes)


 Serious Emotional Impairment


 Specific Learning Disability


 Speech or language Impairment

 Hearing Impairment

 Traumatic Brain Injury

 Mental Retardation

 Visual Impairment, including blindness

 Multiple Disabilities


 Orthopedic Impairment


 Other Health Impairment


2. Services received while in school

(Check appropriate boxes)

 Full Inclusion

 Physical Therapy

 Resource Room

 Occupational Therapy

 Emotionally Disturbed Class (ED)

 Vision Services

 Structured Learning Environment

 Hearing Services



3. Reason(s) services ended

(Check appropriate boxes)

 Earned diploma

 Dropped out but earned GED

 Earned certificate

 Met legal age limit (21)

 Dropped out


4. Reason(s), if student dropped out

(Check appropriate boxes)

 Wanted to

 Parents wanted it

 Needed to work

 Personal problems

Was not doing well and decided to quit


School personnel recommended it


Educational History

5. Number of years student received special education services

              Allegany County

              Other school districts









6. Regular education participation

(during last school year)

  One period per day

  Four or more periods per day

  Two periods per day

  100% of the school day

  Three periods per day


7. The graduate's last IEP contained objectives which include:

(Check appropriate boxes)


 Pre-vocational and/or vocational

 Functional academics


 Life skills

Other agency involvement (DORS, etc.)

 Social skills

 College preparation

 Behavior intervention


8. His/her high school program included: 

(Check appropriate boxes)

 Vocational education

 Community-based learning


 Work-based learning/training

 Employment after school hours


If vocational education is checked above, please indicate program of study, for example commercial sewing, auto mechanics, printing, etc.


Post-Secondary Education And/Or Training

9.Education received since graduation 

(Check appropriate boxes)

 2 year community college


 4 year college or university


 Adult-Education classes (non-credit)


10.Vocational/job training since graduation             

(Check appropriate boxes)

 Vocational/technical school


 Apprenticeship program


 On-the-job training


Work Experience

11. Graduate's current employment status:

 Full-time (37 hours or more per week)


 Not employed

12. How graduate found current job             

(Check appropriate boxes)

 On his/her own

 Teacher or counselor

 Parent,guardian, other relative

 Adult Service Agency(DORS,DDA,etc)

 Employment agency




13. Graduate's current occupation (Write "unemployed' if not working at this time and proceed to #21

14. Length of time employed at current job

15. Current job benefits

(Check appropriate boxes)


 Vision insurance

 Sick leave

 Free meals


 Life insurance

 Health insurance

 Don't know

 Dental insurance


16. Graduate's current job satisfaction


 Very satisfied

 Not satisfied

 Somewhat satisfied

 Very unhappy

17. Graduate's monthly income from current job

18. Problems at current job           

(Check appropriate boxes)

 Doing good work

 People picking on graduate

 Working the entire day


 Boss being happy with graduate's work


People not talking to graduate

 No problems

19. What the graduate likes best about the current job

 The work

 The money

 The people


20. What the graduate likes least about the current job

 The work

 The money

 The people


21. Reason(s) not currently employed

(Check appropriate boxes)

 No job in the area he/she could do

 No transportation

 No one to help him/her find a job

 Health reasons

 No training available for a job

 Job too hard

 Doesn't want to give up SSDI benefits

 Couldn't get along with boss

 Laid off

 Couldn't get along with co-workers


 Attending school



Independent Living And Leisure Activities

22. Graduate's living arrangement


 Alone in his/her own home

 With spouse

 Apartment alone

 With spouse's parents

 Apartment with friend(s)

 Group home

 With parent or guardian


 With relatives


23. Living expenses the graduate pays


 All (rent, utilities, etc.)


 More than half of all

 Don't know

 Half or less


24. Graduate's income source

(Check appropriate boxes)


 Social Security Benefits





25. Graduate's transportation

(Check appropriate boxes)

 Drives own or parents' car


 Bus or taxi

 Rides bike

 Relatives or friends transport


26. Community resources used most


 Shopping facilities


 Homes of friends


 Outdoor recreation (pool, park,etc.)


 Indoor recreation (movies,bowling,etc.


27. Clubs/organizations participation

(Check appropriate boxes)

 Church club

 Exercise class


 Adult Education class



28. Events graduate attends

(Check appropriate boxes)

 Sporting events

 Fairs or festivals

 Concerts or plays




29.Independent living activities performed

(Check appropriate boxes)

 Cooking meals or preparing snacks

 Making change


 Managing bank account

 Household chores

 Writing checks for purchases

 Purchasing food

 Using telephone to get information

30. Graduate is registered to vote




Adult Services

31. DORS services accessed

(Check appropriate boxes)

 Assessment and evaluation

 Vocational and other training services

 Vocational rehabilitation/counseling

 Rehabilitation technology

 Job search,placement,follow-up

 Support services

 Medical rehabilitation


32. DDA services accessed

(Check appropriate boxes)

 Day habilitation

 Behavior/support services

 Community residential services

 Supported living arrangements

 Supported employment


 Family/Individual support services


33. MHA services accessed

(Check appropriate boxes)

 Mental health evaluation/treatment

 Supported employment

 Psychiatric rehabilitation programs

 Respite care

 Residential rehabilitation programs