I live in...
Shasta County
Tehama County
Trinity County
Other:
How old are you?
14
15
16
17
18 or older
What is your gender?
Male
Female
Where do you live?
On my own
With parents or guardian
With relatives
With my foster family
In a Group Home
With a friend's family
With my spouse / boyfriend or girl friend
In a juvenile detention center
What Grade are you in?
9th
10th
11th
12th
What classes are you taking? - Check all that apply
I am taking core academic classes (English, Math, Science, Social Science)
I am taking PE
I am taking art
I am taking music
I am taking career-technical classes (Business, Computer, Family/Life Science,
Industrial Technology, Agriculture)
I am taking ROP
I am taking WorkAbility
I am taking Work Experience.
Do you participate in these school activities? - Check all that apply.
Student Government
Sports
Clubs on Campus (Key, Drama, Chess, recycle...)
Student Organizations (FBLA, FFA, FHA)
Band
Choir
Yearbook
Student Newspaper
Volunteer / Community Service
Graduation - where do you stand? - Check all that apply.
I plan to graduate from high school.
I plan to earn a high school diploma.
I plan to take the GED.
I will earn a certificate of completion instead of a diploma.
I am worried about graduating from high school.
What are some of the biggest challenges you face when you think about graduation?
Check all that apply.
Credits
Classes I have to take to graduate
Senior Project
Earning a diploma
Being able to find a job
I need to work and go to school.
Other:
How would you rate your school experience? - Check all that apply.
I like school and enjoy most of my classes.
My classes challenge me.
I am proud of my success in high school.
I am learning what I need to know.
I wish school would teach me what I need to know about working.
I wish school would teach me about living independently.
I like school, but get frustrated in some classes.
I dislike school.
If you are taking this survey, you are receiving help in special education.
Yes
No
Are you in a special day class?
Yes
No
Are you in a resource specialist program?
Yes
No
Are you receiving help from a special education teacher?
Yes
No
Special Education is helping me be successful in my classes.
Do you know how you learn best? - Check all that apply.
I am learning the skills I need for work and at home in my classes.
I am aware of my disability.
I know my learning style and how I learn best.
My teachers allow me to use my learning style and strengths.
I know how to ask for help in my classes or at work.
I wish I knew more about why I am in special education.
I know what accommodations I need.
Tell us about your IEP. - Check all that apply.
I look forward to my IEP meeting.
I rarely talk in my IEP.
I know why we have IEP meetings.
I participate in my IEP and tell people what I need in the IEP.
My IEP helps me plan my future.
Are you ready for life after high school? - Check all that apply.
I am confident that I am ready to leave high school.
I am scared of life after high school.
I have certificates or a portfolio that shows my work related skills and training.
I know where I want to work.
I know where to get help to get a job.
I want to continue with my education or training.
I know where I want to go to continue my education or training.
I know where to get help to continue my education and training.
I know how to live independently and take care of myself.
I have transportation and know my way around the community.
I know how to manage my money.
I have the support I need (family encouragement, money, resources).
There is a computer at home that I can use.
I know where I can go in the community to use a computer.
I have an email address.