<p> EARLY INTERVENTION PROGRAM www.iu17.org 1-800-326-8528</p><p>Dear Parents:</p><p>We are committed to a quality Early Intervention Program and would like your input regarding our services. Please take a few minutes to answer the following questions and include any comments or suggestions that you feel will be helpful to us. Your honesty and cooperation are appreciated and will help us to improve. Please return this survey to us by July 11, 2003. A pre-addressed, stamped envelope is enclosed for your convenience. Thank you. Parent Survey 2002-2003</p><p>1. How long have you been receiving Early Intervention services from BLaST Intermediate Unit #17? ______</p><p>2. Where did you learn about BLaST Intermediate Unit #17’s Early Intervention services?</p><p>_____ Transition from MH/MR _____ Head Start _____ Doctor/Clinic _____ Newspaper Ad _____ Community Screening _____ Other – Please list _____ Preschool/Day Care ______</p><p>3. Do you have any suggestions how we might better reach children who may be in need of service? ______</p><p>4. Which Parent Trainings offered by BLaST Intermediate Unit #17 did you attend?</p><p>Oct 2002 Early Childhood Conference ______Nov 2002 Autism Conference ______Feb 2003 Transition Training for Parents ______Mar 2003 Why Do Children Misbehave? ______May 2003 Families Learning Together ______</p><p>I did not attend any Parent Trainings ______</p><p>5. Please list any specific needs or suggestions for parent training. 1 ______(over)</p><p>6. Are you aware that all Early Intervention services are confidential? Yes ______No ______</p><p>7. Are you aware of the BLaST website, www.iu17.org? Yes ______No ______</p><p>Use this key to help you answer the following questions:</p><p>A = Always S = Sometimes N = Never D = Don’t Know</p><p>8. Have you accessed and found the BLaST website useful? A S N D</p><p>9. Has your Early Intervention (EI) staff person provided information regarding the Local Interagency Coordinating Council (LICC)? A S N D</p><p>10. Do you participate in activities of your Local Interagency Coordinating Council (LICC)? A S N D</p><p>11. Has your EI staff person provided information based on your child’s needs? A S N D</p><p>12. Has your EI staff person provided information based on your family’s needs? A S N D</p><p>13. Has your EI staff person provided information on typical childhood social and behavioral growth and development? A S N D</p><p>14. Has the EI staff been sensitive to the cultural concerns of your family? A S N D</p><p>15. Does the EI staff respond to your concerns in a timely manner? A S N D</p><p>16. Has your EI staff person provided information or activities to develop early literacy skills with your child? A S N D</p><p>17. Does the EI staff give you support, suggestions, activities and ideas to use between visits? A S N D</p><p>18. Do you feel comfortable following through with these learning activities? A S N D</p><p>19. Do you feel you have been an equal partner in developing a program for your child? A S N D</p><p>20. Were you satisfied with the transition process from Infant-Toddler (MH-MR) programming to BLaST IU #17 programming? A S N D</p><p>21. Does the EI staff help you with planning for your child’s entry to the 2 public school system? A S N D</p><p>22. Were you satisfied with the transition process from BLaST IU #17 programming to school age programming? A S N D</p><p>23. Were you satisfied that your child is learning skills to be successful in kindergarten? A S N D</p><p>24. Overall, have EI services provided by BLaST IU #17 been a benefit to your child and family? A S N D</p><p>In what way?</p><p>______</p><p>Other comments:</p><p>If you have any questions, please contact your local service coordinator:</p><p>Dan Knapp Karen Rush (570) 673-6001 (570) 323-8561 [email protected] [email protected]</p><p>Optional:</p><p>Name: ______</p><p>Address: ______</p><p>______</p><p>Phone: ______</p><p>3 A Regional Education Service Agency Serving Bradford, Lycoming, Sullivan, and Tioga Counties An Equal Opportunity Employer In Compliance With Title IX and Sections 503 and 504</p><p>4</p>