Pre-Visit Survey

Welcome! We are so pleased that you have decided to visit our school site. We appreciate receiving the information below so that we can tailor your visit to suit your group's individual needs and interests.

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* 1. Name:

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* 2. Position supporting children:

General Education Teacher

Special Education Teacher

School SIte Administrator

District Level Administrator

Parent

Paraprofessional

School Psychologist

Speech and Language Pathologist

Occupational Therapist

Local, State or Federal Government Position

University Faculty

University Student

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* 3. Affiliation (Name of school, district office, university, etc)

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* 4. Phone:

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* 5. Email:

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* 6. You may focus your visit at CHIME by choosing up to three topics from the menu below. Please prioritize your choices by numbering their boxes:

School-wide organization

Organization and methods of collaboration and co-teaching

Integration of instructional supports and services

Research based reading remediation

Design of paraprofessional supports

Paraprofessional staff development

Social skills instruction

Curricular adaptations and modifications

Data collection for documenting progress towards IEP goals

Family communications and partnerships

Active learning

Thematic instruction

Constructivist approach

Please take a moment to indicate your level of expertise in each of the following areas by marking the
appropriate number. ( 1 indicates the least amount of knowledge, 10 the most.)

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* 7. I know how to organize a school for inclusive support of students with disabilities.

Explain:

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* 8. I understand how teachers must collaborate in order to accommodate the needs of all students in the General Education classroom.

Explain: