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University of Central Florida
Inclusive Education Services Application
Inclusive Education Services Admissions and Application Consideration Process
The University of Central Florida’s Inclusive Education Services unit within the Student Development and
Enrollment Services division offers students with intellectual disabilities an inclusive, comprehensive nondegree seeking academic initiative with a vocational focus. The program is designed for two to four years in
length based on student goals. Students who have graduated from the K-12 education system are eligible for
participation. This is not a dual-enrollment program.
At this time, this experience is not an accredited college degree program and exiting students will receive a
certificate of completion, NOT a degree or official certificate from the University of Central Florida. The target
audience for this concept is students who desire a college experience but would not be eligible to participate in a
traditional state college or university degree program curriculum with or without accommodations.
Students should consider this program if:
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Interested in pursuing academic interests on a college campus
Ready to make a commitment to furthering academic, professional, personal, and social development
Desiring to become gainfully employed upon completion of the UCF experience and willing to learn
vocational skills to reach that goal
The candidate’s family/guardian and support system are committed to a collaborative partnership with
the University of Central Florida
Students should not consider this program if:
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Parents want the candidate to participate in the program, but the candidate is not motivated to continue
their education and professional development
The candidate feels ready to live independently, but primary supports in the candidate’s personal
network do not feel as though the student can be successful in the college environment
The candidate has a recent history of frequent absences and/or behaviors that impacts participation in
academic and vocational experiences with no corrective action measures in place
It is important to understand that UCF faculty and staff will work with students in this cohort in the same
manner as any other enrolled student. Through our immersive and inclusive experience, we are promoting
independence. Activities within the norm or considered "age appropriate" for other college students will not be
managed by university staff unless in violation of UCF's code of conduct. Parents/guardians should establish
clear boundaries and communication with their student.
Additional information on Inclusive Education Services can be found at http://ies.sdes.ucf.edu/. Questions
about the application process can be emailed to [email protected].
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Essential for Admissions Consideration:
For this initial launch, it is essential that candidates be able to meet the following for consideration in the Fall
2015 cohort:
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Meet personal care needs whether independently or by privately contracting with a personal care
assistant
Independently and accurately manage and administer their medications
Adhere to the University of Central Florida student code of conduct: http://osc.sdes.ucf.edu/process/roc
Be able to prosper given the resources available through the UCF’s Inclusive Education Services and
natural campus-wide resources (keeping in mind this is a developing concept)
Further, the program will consider individuals who meet the following criteria:
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Have a strong desire and motivation to fully participate in and be successful in this initiative
Have a desire for on-going learning and pursuit of knowledge
Have an identified intellectual disability as evidenced within the provided documentation
Have received a diploma, certificate of completion, or equivalent from a high school program
The individual needs of the student are such that they can be appropriately and reasonably met by UCF
faculty and staff and/or community resources in conjunction with UCF faculty and staff
Possess the self-reliance and responsibility necessary to be able to safely and independently navigate
around campus, function within the classroom, live successfully within his/her apartment, etc. with
minimal to no supervision over a sustained period of time
Demonstrate acceptable emotional regulation and social behavior as well as the ability to get along with
peers, follow rules, and accept supervision; display a level of social maturity conducive to a college
environment
Communicate effectively and work collaboratively with UCF faculty and staff with or without assistive
technology
Exhibit the flexibility to adapt to change successfully with reasonable levels of support
Be able to participate in a 4 – 6 hour personal interview and campus visit if the application advances
Please note: Candidates who are committed to living on campus in UCF Housing will be given some
preference over students who are considering off-campus living
The candidate must have the necessary income and support resources to pay for the full cost of attendance,
which is estimated at $5,800 – 7,500 per semester and includes the following expenses:
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Academic unit fees
Room and board
Course materials and textbooks
Finances to support general daily living and student campus experiences
Transportation outside of UCF shuttle routes
UCF is exploring possible financial assistance options but none can be guaranteed at this time (see Part C:
Optional Supplemental Financial Information Form).
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Application Consideration and Selection
The application will be available April 17 – May 8. Application information may be scanned and emailed to
[email protected] by 11:59pm on May 8th. Application information may also be submitted by mail and must be
postmarked by May 8th. The mailing address is:
Inclusive Education Services
(C/O) Student Accessibility Services
4000 Central Florida Blvd.
Ferrell Commons 7F Room 185
Orlando, FL 32816-0161
The applications can be typed and/or printed neatly. Prospective students are encouraged to complete as
much as possible on their own with assistance from parents and guardians as needed. All information
listed in the checklist must be submitted for the application to be considered complete. Incomplete applications
will not be considered. You may attach additional information and pages for writing space if needed. All
information is confidential and will not be shared with any outside agencies unless written agreement is
provided by those filling out the application. Information will not be returned or duplicated for any purposes.
Two ‘Letters of Recommendation’ must be included in a sealed envelope with signature across the seal,
emailed to Inclusive Education Services ([email protected]), or may be mailed directly to Inclusive Education
Services.
Applications will only be considered after ALL requested information is received. An Application Committee
will review applications and select students for an on-campus interview. The committee will place significant
emphasis on:
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The student’s motivation to be a UCF student and the student’s consistent, continuous desire to learn;
Recent work and volunteer history;
The student’s desire for employment after graduation;
The student’s desire to live on campus (encouraged but not required);
The student’s ability to live independently on campus, including in our residential community, within
the resources available through the UCF’s Inclusive Education Services and natural campus-wide
resources;
Student’s ability to adhere to the UCF’s student code of conduct: http://osc.sdes.ucf.edu/process/roc
Individual interviews and campus visits lasting 4 - 6 hours for 10 candidates will be held throughout the month
of June. You will receive a letter, email, or phone call letting you know of your application status at each stage
of the process.
The decision to offer admission to the program will be made by the Screening Committee in their best judgment
and in the best interest of the candidate based on the overall quality and diversity of the pool of applicants. The
previously mentioned criteria will be the baseline against which decisions are made in conjunction with the
completed application packet. In addition to the abilities of the student, the capabilities of Inclusive Education
Services and the UCF community to engage effectively with the student will also be considered.
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UCF INCLUSIVE EDUCATION SERVICES APPLICATION CHECKLIST
Information within the UCF Application Packet to be completed for consideration:
❏ Part A: UCF Admissions Application for Inclusive Education Services and General Information
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UCF Admissions Information
Student Information
Family Information
Transportation Checklist
Student’s Legal Rights
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Employment and Volunteer History
Extracurricular Activities/Involvement
Student Essay/Video
Skills Assessment
Graff Parent Readiness Scale (GPRS)
❏ Part B: Two Confidential Letters of Reference**
o One from someone in the academic/educational setting
o One from someone in the vocational or community setting
**References forms to be used are posted on the http://ies.sdes.ucf.edu/. Information for how to
return completed forms is listed at the bottom of each document.
❏ Part C: Optional Supplemental Financial Information Form
o Must be completed if seeking financial assistance from UCF
o Please note that possible financial assistance options are being explored at this time
Additional information to be collected and submitted with the UCF Application for consideration:
❏ Official High School Transcript (including disciplinary records if any)
❏ Verification of intellectual disability diagnosis via any of the following options (only one item needed
but additional information may be submitted as deemed beneficial):
o Most recent IEP
o Educational/Psychological evaluations and assessments conducted within the past three years,
including a measure of intelligence, achievement, and adaptive behaviors
o Other document(s) with third party diagnosis verification
❏ Proof and Acknowledgement of Guardianship signature page and document, if applicable
If accepted for Fall 2015 (final decisions to be made by July 1st), the student and family will be asked to
complete the following prior to the Fall semester beginning on August 24th:
❏ Provide a $500 non-refundable deposit within 7 business days of invitation of the Inclusive Education
Services program in order to secure placement for the Fall 2015 semester.
❏ Provide a $30 application fee and cover any additional costs related to registering for classes and oncampus living.
❏ Attend an initial Welcome Meeting to discuss overview of next steps, determine academic schedule, etc.
❏ Sign Student and Family Contract during initial meeting
❏ Sign Communication Consent during the initial meeting
❏ Participate in a FAAST technology assessment in July to explore beneficial technology resources
❏ Proof of health insurance or statement that student and family/guardian understand that the student will
need to purchase the health insurance through UCF; needs to be finalized by August 15th
❏ Complete the UCF Immunization Form (http://www.cmms.ucf.edu/files/Immunization Form.pdf) as
quickly as possible; form needed on file in order to select a Fall course schedule
❏ Move onto campus August 16th (if applicable)
❏ Participate in pre-semester activities, orientations, and trainings August 17th – 21st
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University of Central Florida
Inclusive Education Services Application: Part A
Personal Information
First Name: _________________ Middle Name: ________________ Last Name: ________________________
Date of Birth (mm/dd/yy): _______________
Are you Hispanic or Latino?:
❏ Yes
❏ No
Gender:
❏ Male
❏ Female
How do you describe yourself?:
❏
❏
❏
❏
❏
American Indian/Alaska Native
Asian
Black/African American
Native Hawaiian or Other Pacific Islander
White
Are you a U.S. Citizen?
❏ Yes
❏ No
If yes, were you:
❏ Born a U.S. citizen
❏ Naturalized
If no, what is your nation of citizenship? ______________________
What is your current visa status in the United States? __________________________
(please provide copies of your visa/EAD/permanent resident card or other documentation)
Do you have a documented disability for which you need services if offered admission and enroll at UCF?
❏ Yes
❏ No
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U.S. Vet/Military Status:
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❏
❏
❏
❏
Active
Educational Benefit Eligible Dependent
Veteran Service prior to 9/11/2001
Veteran Service on or after 9/11/2001
No Military Service
Is your native language English?
❏ Yes
❏ No
If no, how many years have you spoken English? _________
Student Permanent Address
Address: _________________________________________________________________________________
_________________________________________________________________________________
City/State: ____________________ Postal Code: ____________________ Country: ____________________
Cell Phone Number: __________________________ Home Phone Number: __________________________
Email Address: ___________________________________________________________________________
* UCF will communicate with you through this address.
Emergency Contact
Emergency Contact Name: __________________________________________________________________
Relationship:
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Father
Friend
Guardian
Mother
Other Relative
Spouse
If not Parent, location of Parents: _____________________________________________________________
Emergency Contact Address:
_______________________________________________________________
_______________________________________________________________
City: _________________________ State: ______________________ Postal Code: ____________________
Country: ________________________ Emergency Contact Phone: __________________________________
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Parent/Guardian Contact
Parent/Guardian #1 Name: __________________________________________________________________
Relationship:
❏
❏
❏
❏
❏
Father
Legal Guardian
Mother
Step-Father
Step-Mother
Phone Number: __________________________
Type:
❏ Cellular
❏ Permanent
❏ Work
Occupation: ______________________________________________________________________________
Highest Level of Education:
❏
❏
❏
❏
❏
❏
No High School
Some High School
High School Diploma or GED
Some College
Bachelor's degree
Graduate School
Email Address: ___________________________________________________________________________
* UCF may communicate with them through this address.
Parent/Guardian Contact
Parent/Guardian #2 Name: __________________________________________________________________
Relationship:
❏
❏
❏
❏
❏
Father
Legal Guardian
Mother
Step-Father
Step-Mother
Phone Number: __________________________
Type:
❏ Cellular
❏ Permanent
❏ Work
Occupation: ______________________________________________________________________________
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Highest Level of Education:
❏
❏
❏
❏
❏
❏
No High School
Some High School
High School Diploma or GED
Some College
Bachelor's degree
Graduate School
* UCF may communicate with them through this address.
Family Information
How many people, including yourself, live in your household:_______________________________________
What is your household/family income:
❏
❏
❏
❏
❏
Less than $20,000
$20,000 - $39,999
$40,000 - $59,999
$60,000 - $79,999
More than $80,000
Application Information
Application Term:
❏ Fall 2015
Educational Information
HS Attended: _____________________________________ City and State: ___________________________
Date of graduation: _____________________
Did you earn a GED?
❏ Yes
❏ No
Date of GED diploma: _______________________
Have you attended any Post-Secondary institutions (Colleges or Universities)?
❏ Yes
❏ No
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If YES, please enter the information below:
Institution Name
City
State
Please indicate below if you have taken or plan to take:
❏ SAT (mm/yy): ___ _____
❏ ACT(mm/yy): ___ _____
❏ FAA(mm/yy): ___ _____
Country
Start Date
(mm/dd/yy)
End Date
(mm/dd/yy)
Number
of
Credits
Earned
Select any as appropriate:
AP
AICE
IB
CLEP
Last test date: _______________
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Crime/Disciplinary Questions
NOTE: You do not need to disclose any academic dismissal, suspension or probation that was due entirely to poor grades. If you
answered any of the questions below with a “YES”, please list all actions or charges and provide specifics. Note that this question
includes any charges of misconduct at an educational institution, even if the matter was subsequently dropped or resolved in your
favor.
Are you currently or have you ever been subject to disciplinary action for misconduct at an educational
institution?
❏ Yes
❏ No
If YES, please explain below:
Have you ever been convicted of a felony?
❏ Yes
❏ No
If YES, please explain below:
In the past 10 years, and including any pending charges, have you ever been the subject of any criminal
proceeding other than a minor traffic violation? DUI is a crime, not a “minor” traffic violation. If in doubt
about what constitutes a “minor” violation, you should answer YES to this question and provide specifics
below.
❏ Yes
❏ No
If YES, please explain below:
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NOTE EXPUNGED RECORDS: We are not responsible if records you believe were expunged are revealed to the university. Please
provide any specifics on a separate sheet of paper which you did not have space to include. Signature is required on separate
documents attesting to the validity of statements made.
Disciplinary History Verification: I understand that withholding information requested or falsification of information given will result
in disciplinary action and may make me ineligible for admission and enrollment and that by accepting my application for admission,
the University of Central Florida accepts my commitment to observe all regulations of the university.
Please verify that all the information above is correct.
IMPORTANT: You must read and sign the following section in order to complete your application to
UCF.
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I understand that this application is for admission to the University of Central Florida and is valid only
for the term chosen.
I understand and agree that I will be bound by the university’s regulations concerning application
deadline dates and admission requirements.
I agree to the release of any transcripts, student records, and test scores to this institution. All application
materials submitted, including transcripts and test scores, become the sole property of the university.
I certify that the information given in this application is complete and accurate and I understand that to
make false or fraudulent statements within this application or residence statement may result in
disciplinary action, denial of admissions, and invalidation of credits or degrees earned. Should any of the
information I have given change prior to my enrollment, I shall notify the Office of Undergraduate
Admissions.
If admitted, I hereby agree to abide by the policies of the Board of Trustees and the rules and regulations
of the university.
I understand that, if selected to participate in the Inclusive Education Services Initiative for Fall 2015,
there will be $30 non-refundable application fee. Fee waivers will be considered for those
demonstrating financial need. No money is due at the time of application.
I understand that by signing my name below, I am certifying that I am the person making the application
to the university and that all information is true and accurate to the best of my knowledge.
University of Central Florida Annual Security & Fire Safety Guide
This report includes statistics for the previous three years concerning reported crimes that occurred on campus; in certain off-campus
buildings or property owned or controlled by the University of Central Florida; and on public property within, or immediately adjacent
to and accessible from, the campus.
The report also includes institutional policies concerning campus security, such as policies concerning sexual assault, and other
matters. You can obtain a copy of this report for any of our campus sites by contacting the University of Central Florida Police
Department or by accessing the following web site: http://police.ucf.edu/CrimeStats.html. The Office of Undergraduate Admissions is
providing this information in compliance with the Campus Safety/Security Act of 1990.
I hereby agree to abide by the policies of the Florida Board of Governors and the rules and regulations of the
university. I also authorize the release of my academic progress for research study purposes to authorized
institutions of education. Acceptance resulting from this application applies only to the term indicated herein.
❏ I certify the information provided on this form to be true and accurate.
_________________________________________
_____________________________________
Printed Full Name (Student)
Printed Full Name (Completed By)
_________________________________________
_____________________________________
Signature (Student)
Signature (Completed By)
_________________________________________
Date (mm/dd/yy)
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University of Central Florida
Inclusive Education Services Application: Part
Family Information
Student lives with:
❏ Parent
❏ Mother
❏ Father
❏ Guardian(s)
❏ Other: ___________________________________________________________
Student Information
Student receives support or services from (please check those that apply):
❏ Supplemental Security Income
❏ Agency for Persons with Disabilities
❏ Vocational Rehabilitation
❏ Other (please explain):
Transportation Checklist
Please check all that apply:
❏ I use public transportation independently.
❏ I can independently make my own reservations for door-to-door paratransit systems.
❏ I have a family member or others who provide ongoing private transportation for me.
❏ I can currently cross intersections with pedestrian signals safely and unassisted.
On-Campus Housing
If admitted, my preference would be to live on-campus.
❏ Yes
❏ No
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Medical and Attendance Information
Are there are medical needs that Inclusive Education Services needs to be aware of in the coordination of a
campus experience for the candidate? Please share any information that we need to know about how to best
work with the student on campus and/or issues that could impact consistent participation in academic and
vocational experiences.
Does the candidate have a recent history of frequent absenteeism that would impact academic and vocational
experiences? Please share any past experiences that could impact consistent participation.
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Student Legal Rights
Student name:
Which of the following best describes the student’s legal rights?
❏ Makes own legal/medical decisions/gives consent
❏ Guardianship
❏ Other (please explain):
If the student makes his or her own decisions, this page is complete.
If Guardianship or Other was checked, please provide proof and acknowledgement of
Guardianship signature page and/or other relevant documents for verification in the application
packet and answer the following question in the space provided below:
If your student is admitted into the cohort, what is your expectation for how decisions about
academic and vocational progress will be made with the student in conjunction with UCF
staff/faculty and you, as the guardian?
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Volunteer/Paid Employment Experiences
List three current and/or most recent volunteer experiences (as applicable):
Site #1:
Dates of
Volunteering:
Hours per
Week:
Primary responsibilities:
Support services and accommodations used:
Site #2:
Dates of
Volunteering:
Hours per
Week:
Primary responsibilities:
Support services and accommodations used:
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Site #3:
Dates of
Volunteering:
Hours per
Week:
Primary responsibilities:
Support services and accommodations used:
List three current and/or most recent paid job experiences (as applicable):
Employer #1:
Dates of
Employment:
Hours per
Week:
Rate of Pay:
Primary Responsibilities:
Support services and accommodations used:
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Employer #2:
Dates of
Employment:
Hours per
Week:
Rate of Pay:
Primary Responsibilities:
Support services and accommodations used:
Employer #3:
Dates of
Employment:
Hours per
Week:
Rate of Pay:
Primary Responsibilities:
Support services and accommodations used:
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Extracurricular Activities and Community Involvement
Please list any extracurricular activities and/or personal activities in which the student has taken
part in
past five years:
Extracurricular or Personal Activity
Year(s)
Please list any programs or activities the applicant has completed that have helped you prepare
for higher education or future employment:
Program or Activity
Year(s)
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Essay: The personal statement is a very important part of your application. This information
assists the university in knowing you as an individual, independent of academic and other
information. We ask you to respond to two of the questions below either in the space provided or
on a separate sheet of paper. Each answer should not be longer than 500 words (written or
typed) or 2 minutes of an audio or video file submitted as a .wav file on a flash drive or in
another format that can be easily reviewed.
1. Please answer this question: What do you want to learn as a UCF student?
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Please answer ONE of the following questions:
2. What qualities or unique characteristics do you have that would allow you to contribute
to the UCF community?
3. Describe a challenge that has impacted your academic or personal life. How have you
learned from this experience?
4. Share what makes you excited about possibly attending the Inclusive Education initiative
at UCF along with what makes you the most nervous about possibly attending.
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Parents/Guardians: Please check the box that best represents the applicant’s current skills/level
of assistance. The goal of this assessment is to get a sense of general abilities. There are no
“right answers.”
General Academic Skills
With No
Assistance
With Some
Assistance
With
Significant
Assistance
Don’t
Know
(N/A)
With No
Assistance
With Some
Assistance
With
Significant
Assistance
Don’t
Know
(N/A)
Handling money to make purchases
Counting bills and making change
Staying within a budget
Using a calculator
Using a computer for word processing
Navigating the internet
Following verbal directions
Following written directions
Demonstrating motivation to learn and
persist on new tasks
Maintaining and following a daily schedule
Remembering and keeping up with due
dates/assignments
Writing Skills (with or without the use of
assistive technology)
Generating name
Generating complete words
Generating short sentences
Drafting, revising, and editing
Using any Assistive Technology (AT) to
assist with writing
If yes, please note type of AT used:
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Reading Skills
With No
Assistance
With Some
Assistance
With
Significant
Assistance
Don’t
Know
(N/A)
With No
Assistance
With Little
Assistance
With
Significant
Assistance
Don’t
Know
(N/A)
With No
Assistance
With Little
Assistance
With
Significant
Assistance
Don’t
Know
(N/A)
Recognizing familiar words and names
Reading short books
Reading chapter books
Retelling beginning, middle, and end of
stories
Identifying characters and setting of a text
Identifying major events of a text
Independent Living Skills
Finding way around new environment
Following a schedule
Ordering and purchasing from a restaurant
Finding items in a store and making
purchases
Uses a debit card
Uses email
Uses cell phone
Social Skills and Communication
Dealing with conflict
Distinguishing between friends and strangers
Interacting appropriately with peers
Greets others appropriately
Engages in conversation
Establishes relationships with friends
Maintains relationships with friends
Participates in social activities
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Responds appropriately to people in
authority
Recognizes and responds appropriately to the
emotions of others
Demonstrates good safety habits/judgment in
social situations
Works well in group situations
Active Participation
With No
Assistance
With Little
Assistance
With
Significant
Assistance
Don’t
Know
(N/A)
With No
Assistance
With Little
Assistance
With
Significant
Assistance
Don’t
Know
(N/A)
Recognizes his/her own emotions
Communicates needs to others effectively
Expresses his/her opinions appropriately
Problem solves
Finds help when needed
Asks questions when clarification is needed
Works to improve performance
Responds to feedback appropriately
Activities of Daily Living and Self-Care
Demonstrates personal care habits (e.g.,
brush teeth, comb hair)
Completes morning routine in a timely
manner
Selects appropriate sleep schedules
Does laundry using a washing machine and a
dryer
Maintains a clean and organized living area
(e.g., sweeps, wipes down counter tops,
makes bed, puts clothes away)
Manages personal belongings (e.g., ID, cell
phone, keys)
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With No
Assistance
With Little
Assistance
With
Significant
Assistance
Don’t
Know
(N/A)
Arrives at work/volunteer site on time
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Attends work/volunteer site when scheduled
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Follows supervisor’s directions
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Works well with co-workers as a team
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Work/Volunteer Skills
Dresses appropriately for the work/volunteer
site
Completes assigned work/volunteer tasks
Additional Information
Is there anything else that would be beneficial for us to know about the student’s volunteer or
paid work experience, extra curricular activities, or current skills?
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Graff Parent Readiness Scale (GPRS)
Parents/Guardians: This scale helps determine the families’ readiness for the student with an
intellectual disability to attend a post-secondary program. We have provided two copies of this
form so that each primary family/guardian member (up to two) should individually fill out the
following scale.
1=I strongly disagree, 2= I disagree, 3=I neither agree nor disagree, 4=I agree, and 5=I
strongly agree.
Name of person completing this scale:________________________
1. I expect to know everything my student does at the university.
❏ 1
❏ 2
❏ 3
❏ 4
❏ 5
❏ 3
❏ 4
❏ 5
❏ 4
❏ 5
❏ 4
❏ 5
2. I expect one-on-one support all day.
❏ 1
❏ 2
3. I worry about my student talking to other students unsupervised.
❏ 1
❏ 2
❏ 3
4. I worry about my student crossing the street.
❏ 1
❏ 2
❏ 3
5. I would like to attend classes to see my student interact with others.
❏ 1
❏ 2
❏ 3
❏ 4
❏ 5
❏ 4
❏ 5
❏ 3
❏ 4
❏ 5
❏ 3
❏ 4
❏ 5
❏ 4
❏ 5
6. Often, I am in contact with my student more than 3 times a day.
❏ 1
❏ 2
❏ 3
7. Often, I am telling my student what to do and say.
❏ 1
❏ 2
8. I believe I know what is best for my student.
❏ 1
❏ 2
9. I feel that my student knows what is best for him/herself.
❏ 1
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❏ 2
❏ 3
25!
Graff Parent Readiness Scale (GPRS)
Parents/Guardians: This scale helps determine the families’ readiness for the student with an
intellectual disability to attend a post-secondary program. We have provided two copies of this
form so that each primary family/guardian member (up to two) should individually fill out the
following scale.
1=I strongly disagree, 2= I disagree, 3=I neither agree nor disagree, 4=I agree, and 5=I
strongly agree.
Name of person completing this scale:________________________
1. I expect to know everything my student does at the university.
❏ 1
❏ 2
❏ 3
❏ 4
❏ 5
❏ 3
❏ 4
❏ 5
❏ 4
❏ 5
❏ 4
❏ 5
2. I expect one-on-one support all day.
❏ 1
❏ 2
3. I worry about my student talking to other students unsupervised.
❏ 1
❏ 2
❏ 3
4. I worry about my student crossing the street.
❏ 1
❏ 2
❏ 3
5. I would like to attend classes to see my student interact with others.
❏ 1
❏ 2
❏ 3
❏ 4
❏ 5
❏ 4
❏ 5
❏ 3
❏ 4
❏ 5
❏ 3
❏ 4
❏ 5
❏ 4
❏ 5
6. Often, I am in contact with my student more than 3 times a day.
❏ 1
❏ 2
❏ 3
7. Often, I am telling my student what to do and say.
❏ 1
❏ 2
8. I believe I know what is best for my student.
❏ 1
❏ 2
9. I feel that my student knows what is best for him/herself.
❏ 1
!
❏ 2
❏ 3
26!
!
27!