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Background Information (Optional)

Name:____________________________________

Role? (e.g., parent, teacher, therapist, advocate)____________________

Organization (if any)__________________________

Mailing Address: ___________________________________
___________________________________
___________________________________
Phone:________________ fax:________________ Email:_____________________________


Areas of Concern for Potential Action:


 It is urgent/important It is attainable

1. Definitions		 Disagree Agree Disagree Agree
There are not widely agreed upon
statewide definitions for terms
such as "consult,"
"direct or indirect service,"
"screening," "educationally vs. medically necessary."		 1 2 3 4 5 1 2 3 4 5

2. Referrals		 Disagree Agree Disagree Agree
There is concern that physicians are making referrals for school-
based related services without
having sufficient knowledge of
the educational necessity. 		1 2 3 4 5 1 2 3 4 5

3. Qualified Professionals		 Disagree Agree Disagree Agree
There are an insufficient number of qualified related service
personnel available to meet
the needs of students. 		1 2 3 4 5 1 2 3 4 5




It is urgent/important It is attainable

4. Common Standards		 Disagree Agree Disagree Agree
There is no widely agreed upon set of standards within the state
which summarizes appropriate, promising, and exemplary practices regarding related services (e.g., common goals, decision-making practices, service options, team collaboration, location of services, IEP documentation). 		1 2 3 4 5 1 2 3 4 5

5. Funding		 Disagree Agree Disagree Agree
There is concern that funding sources and school administrative practices, rather than student needs, determine the type and ways that services get provided. 1 2 3 4 5 1 2 3 4 5

6. Information Access		 Disagree Agree Disagree Agree
There is a concern that parents, general education teachers, other school personnel and community members do not have sufficient access to current information about related services in schools. 1 2 3 4 5 1 2 3 4 5

7. Evaluation of Impact		 Disagree Agree Disagree Agree
There is concern that there is limited evaluation data regarding the impact of related service provision on students' education. 1 2 3 4 5 1 2 3 4 5

Additional Comments















Return this Questionnaire by June 13, 1997 to:

Michael F. Giangreco
Center on Disability and Community Inclusion
University of Vermont
101 Cherry Street, Suite 450
Burlington, Vermont 05401-4439

or Fax to 656-1357