Needs Assessment

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Part I. Demography

The law requires that certain information be gathered about the respondents for the purpose of data analysis and for the possible audit of our needs assessment procedure. Individual responses will be treated confidentially. Statistical summaries will be the only data reported publicly.

A. Which of the following describes your PRIMARY role?

If Other, Specify:

B. Please check the school district in which you work or the school district in which your child attends school.
(Please Select Only One)

Edwards Co.C.U.#1 Harrisburg C.U. #3 North Wayne C.U. #200
Gallatin Co. C.U.S.D. #7 Allendale C.C. #17 Wayne City C.U. #100
Hamilton Co. C.U. #10 Wabash C.U. #348 Grayville C.U. #1
Hardin Co. C.U. #1 Fairfield C.U. H.S. #225 Norris City-Omaha-Enfield CU #3
Pope Co. C.U. #1 Fairfield S.D. #112 Carmi-White Co. C.U. #5
Carrier Mills-Stonefort C.U.#2 Geff C.C. #14 Wabash & Ohio Valley S.E.D.
Eldorado C.U #4 Jasper C.C. #17 Other
Galatia C.U. #1 New Hope C.C. #6




C. Please check the age range(s) below of children with disabilities you serve or the age range that best describes your child.

Birth to 3 Intermediate (9-11) Senior High (14-21)
Pre-School (3-5) Jr. High (12-13) N/A
Primary (6-9)

D. Please select the type of school in which you serve or the school that your child attends.