Survey Interview Guide
- 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?
- 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?
- 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?