Early ACCESS Transition Survey
Region 13

1. Today's date is: (mm/dd/yyyy)


2. What is your school district?


3. What is your child's date of birth? (mm/dd/yyyy)


4. How old was your child when he/she entered Early ACCESS?
0-6 months  
 1 yr - 1 1/2 yrs  
 2 yrs - 2 1/2 yrs  
7-12 months  
 1 1/2 yrs - 2 yrs  
 Over 2 1/2 yrs  

5. Of the following daycare or preschool settings, what is your child currently a part of : (mark all that apply)
Child care in a home setting
 Preschool
 Other
Child care in a day care center
 Head Start
Early Childhood Special Education
 Home

6. If you answered "other" in the question above please provide the name of the program.



 Yes No Unsure
7. Did your service coordinator hold a transition planning meeting with you 3-6 months before your child's third birthday? 
8. Were your child's strengths and needs considered during transition planning? 
9. Did your service coordinator share options available for your child? 
10. Did your service coordinator review or share the 'Transition Toolbox' with you? 
11. Do you feel your input was an important part of the transition planning? 


Yes No
12. Did your child qualify for services with an IEP? (if no, please skip to question 20; if yes, continue to question 13)