Special Education Questionnaire Please Note: Due to many frequent spam form submissions, we have added captchas to all of our forms. If you forget to fill out the captcha at the bottom of the form, just hit your browser's back button. This should take you back to the version of the form that had all the information filled out. You can then fill out the captcha at the bottom of the form. Also, you may always call us if you prefer.Your NameTelephone Number(s)Email AddressHome AddressCity, State, Zip CodeEmployerHow did you hear about us?phone bookanother attorneybar associationotherSpecial Education QuestionnairePlease note there is no limit to the amount of information you can enter. The boxes will scroll as necessary as you add additional information.Student InformationAge, Grade.If the student has repeated any grade(s), which grade(s) were repeated and when?Why does the student qualify for special education -- what are his or her qualifying eligibility(ies)?When (grade, year) did student first receive special education?Schools student has attended since kindergarten.School student will attend next school year.Placement.General education classSelf contained class (8 or fewer students)Mixture of general ed and pull outName of school, address, phone and fax numbers.High school your school feeds into.Current Principal and student's teachers.Student's class(es).Evaluation Specialist (ES) at school (Albuquerque Public Schools only), and phone number.Program Support Specialist for Cluster (PSS) (Albuquerque Public Schools only), and phone number.How many IEPs have you attended for student this school year?Date of current IEP and how long (number of hours) were meeting(s) for current IEP?Is the IEP as written appropriate to meet student's educational needs?YesNoIf not, why not?Is IEP being implemented or followed by School?YesNoIf there are problems with the implementation, what are they?What related services does student receive?Occupational therapy (OT)Speech & language therapyPhysical therapy (PT)Assistive Technology (AT)Adaptive Physical Education (APE)OtherDoes student have a Behavior Intervention Plan (BIP)?YesNoIf the student has any disciplinary problems at school, please describe.If the student has been suspended from school, how many times this year, and the total number of days suspended this school year?Can student read well?YesNoCan student spell well?YesNoIs student's handwriting legible?YesNoIs student's handwriting slow or laborious?YesNoCan student do written work easily?YesNoWhat is student working on in math?How are student's math skills?What does student have trouble with at school?How does student do with homework?If the student takes any medications, which medication, why, and who is the prescribing doctor?What kinds of grades is student receiving?Is parent receiving progress reports (at same intervals as grade cards) describing student's progress toward IEP goals?YesNoDoes student like or dislike school?Likes SchoolDislikes SchoolBothWhat does the student like about school?What does the student dislike about school?Please list any individual(s) who work with student at school who you trust and feel best understand student's educational needs. What is this person s job at the school?If you have filed a state level complaint, what was the result?If you previously filed a due process request, what was the result?Have you worked with any organizations on the student's problem?YesNoIf yes, which ones?Parents Reaching Out (PRO)Parents for Behaviorally Different Children (PBDC)Southwest Branch of International Dyslexia Association (SWIDA)New Mexico Learning Disabilities Association (NMLDA)ARCANew Mexico Autism SocietyOtherIf Other, which organization(s)?Do you believe your child's educational needs are met at school?YesNoIf no, which needs are not being met?What are your goals? What do you want to accomplish?Please describe your child's emotional health at the present time as relates to school.Please add any other information you feel is important.
