Estimated time to complete survey:  5-10 minutes

Part 1. Demographics

The law requires that certain information be gathered about those taking the survey for the purpose of data analysis and for the possible audit of our needs assessment procedure. All respondents will remain anonymous, and individual responses will be treated confidentially.

A. Which of the following describes your role?

B. Please check the school district(s) in which you work or the school district in which your child attends school:

Anna C. Cons #37
 Anna-Jonesboro HS #81
 Carbondale Elementary #95
Carbondale HS #165
 Comm. Consol Dist. #204
 Cobden Unit #17
Desoto Consolidated #86
 Dongola Unit #66
 Du Quoin C.U. #300
Elverado Unit #196
 Giant City Elem. #130
 Jonesboro Com. Cons. #43
Lick Creek Com Cons. #16
 Murphysboro C.U. #186
 Pinckneyville Grade #50
Pinckneyville HS #101
 Shawnee Unit #84
 Tamaroa Grade #5
Trico Unit School #176
 Tri-County Special Education
 Unit Point Elem. #140
Other:

C. Please check the age range(s) below of children with disabilities you serve or the age range that best describes your child:

N/A
 Primary (grades K-5)
Birth to 3 yrs
 Jr. High (grades 6-8)
Pre-School (3-5 yrs)
 Sr. High (grades 9-12)

D. Please select the type of school in which you serve or the school that your child attends: