Parent
Input
Questionnaire
 
Date
Requested

_____________________________


Student
Name

____________________________
Person
Completing
____________________________

Date
Returned

____________________________

Education
and
Training

Upon
graduation,
what
do
you
see
your
son/daughter
doing
for
future
education
or
training?

Four
year
college/university

 Community
college

 Technical
college

Military

 Work
based
training
 Community
education
 Other
______________



What
will
your
son/daughter
be
training
to
be?

________________________________________________________________________________________________



My
son/daughter’s
level
of
motivation
to
succeed
in
the
academic
setting:

High
 Medium
 Low

The
level
of
control
my
son/daughter
believes
he
or
she
has
over
the
decision
making
and
his/her

individual
success:

High
 Medium
 Low

My
son/daughter’s
ability
to
identify
what
he
or
she
needs
and
how
to
get
it:

High
 Medium
 Low



Employment

Upon
graduation,
in
what
kind
of
employment
setting
do
you
see
your
son/daughter

engaged
in?

Competitive
employment
 Full
Time
 
 Part
Time

Self‐employment

Supported
employment
 
 Full
Time

 
 Part
Time



Career
Interest
Areas


Agriculture,
Food
and
Natural
Resources:

Pest
control,
plant
nursery,
forestry,
farming,
agriculture
engineer,
landscape
architect


Government

Police
officer,
inspector,
accountant,
auditor,
lawyer,
park
ranger,
urban
planner

Business,
Management,
Administration

Mail
carrier,
bookkeeper,
word
processor,
court
reporter,
paralegal,
financial
manager

Architecture/Construction

Carpenter,
electrician,
roofer,
drafter,
building
inspector,
architect,
civil
engineer

Arts,
A/V
Technology
and
Communication

Actor,
graphic
designer,
sign
painter,
commercial
artist,
software
designer,
journalist,
writer

Education
and
Training

Library
technician,
teacher
assistant,
teacher,
college
teacher,
principal,
media
specialist

Health
Science

Home
health
aide,
dental
hygienist,
respiratory
therapist,
physician,
surgeon,
pharmacist

Finance

Bank
teller,
loan
clerk,
stockbroker,
insurance
claims
adjuster,
accountant,
economist

Manufacturing

Welder,
Packer,
Computer
control
machine
operator/programmer,
geologic
engineer

Hospitality
and
Tourism




Parent
Input
Questionnaire
 
Date
Requested

_____________________________

Student
Name

____________________________
Person
Completing
____________________________

Date
Returned

____________________________

Cook,
Housekeeper,
Janitor,
Waiter,
Food
Service
or
Hotel
Manager,
Fitness
Trainer

Human
Services

Barber,
Childcare,
Sales
Representative,
Clergy,
Criminology,

Social
Work,
Market
Research

Marketing,
Sales
and
Service

Auto
sales,
retail
sales,
interior
designer,
clothes
designer,
advertising
agent,
sales
rep

Information
Technology

Computer
programmer,
website
designer,
computer
engineer,
database
administrator

Science,
technology,
mathematics,
engineering

Drafter,
radio
operator,
electronics
technician,
surveyor,
engineer,
meteorologist

Law,
public
safety
and
security

correctional
officer,
guard,
firefighter,
police
officer,
lawyer,
judge,
forensic
scientist

Transportation,
Distribution
and
Logistics

Bus
driver,
automotive
technician,
chauffer,
flight
attendant,
travel
agent,
air
traffic
controller



What
job
do
you
see
your
child
working
in
after
graduation?
_________________________________________

List
any

jobs
or
chores
that
your
son
or
daughter
performs
at
home
or
in
the
community?

_______________________________________________________________________________________________________________

List
any
jobs
your
son
or
daughter
seems
to
really
dislike

_______________________________________________________________________________________________________________



Independent
Living

How
do
you
see
your
son
or
daughter
living
after
graduation:

House
 Apartment

 Mobile
Home
 Dorm
 Other


With
whom?

Alone

 With
Family
 With
Friends
 Other
_____________________



Check
areas
that
you
feel
your
son/daughter
will
need
assistance
with:

Money
Management

 Employability
skills

 Transportation

Communication
 
 Self‐care
 
 
 Household
management

Self‐care
 
 
 Nutrition
 
 
 Leisure
activities

Community
involvement
 

 Financial
advisement

Other
______________________________________________________________________________________



Have
you
contacted
or
become
a
client
of?

Vocational
Rehabilitation
 Agency
for
Persons
with
Disabilities

College
Office
of
Disabilities
 Technical
School
 
 Healthcare
providers

Other
__________________________________________________________________________________________



List
3
activities
that
you
would
like
to
see
your
son
or
daughter
to
participate
for
recreation/leisure?

________________________________




________________________________



_______________________________



Finally….



What
is
your
dream
for
your
son/daughter?
_____________________________________________________________

What
is
your
greatest
concern?
____________________________________________________________________________




Parent
Input
Questionnaire
 
Date
Requested

_____________________________

Student
Name

____________________________
Person
Completing
____________________________

Date
Returned

____________________________