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Survey Interview Guide

Personal information

  • What is your name, date of birth, Social Security number, phone number and address?
  • With whom do you live?
  • Are you a US Citizen?
  • What language(s) do you speak?
  • In what languages do you read and write and how well?

Disability history

  • What is the name of your doctor(s) or clinic?
  • Are you being treated for any medical or mental health conditions? This could include special education classifications listed on your Individualized Education Program (IEP).
  • Do you take any medications? If you answered yes, do you know the name of your medicine(s) and how it/they help(s) you?


  • What grade have you completed?
  • Do you have an IEP or a 504 Plan? If yes, what services do you receive at school and why? This could mean things like getting extra time when you take a test, or having a tutor who gives you extra help with your school work.
  • Do you have any difficulties with your classes? If yes, which classes?
  • What are your favorite classes and why?


  • Do you have a work history? If yes, what types of jobs have you had and when?
  • Do you have any volunteer experience?
  • Do you have vocational goals?
  • What type of career would you like when you leave school?

Program expectations

  • What kind of assistance or services would you like to get from DVRS?
  • How do you see your disability as interfering with your ability to work?