NAEAACLD Pre-Training Questionnaire

The following questions are not meant to serve as a means of eliminating participants.  The collection of this information is simply to evaluate the potential of future parent leaders.
 
1.

What are your interests in receiving this training?  Check all that apply.
parent of a child with a disability
educator
community advocate
Other  
2.

Have you been exposed to the special education process in your area?  If so, how?
Yes
No
  • Comment:

  • 500 characters left.
3.

Are you comfortable speaking in front of groups of people?
Yes
No
4.

Are you comfortable talking to news reporters?
Yes
No
5.

Are you easily intimidated by people who are perceived as having more education or background on a topic than you have?
Yes
No
6.

Do you have any mediation experience?
Yes
No
7.

Do you have any previous presentation or training experience?
Yes
No
8.

Are you active in your community?  If so, give examples.
Yes
No
  • Comment:

  • 500 characters left.
9.

How much time do you have in your schedule to realistically allow you to participate in this project?
 

  • 350 characters left.
10.

Do you have any involvement (past or present) in your local public school system?  If so, please list examples.
Yes
No
  • Comment:

  • 500 characters left.
11.

Are you easy to talk with?  (Example:  Do others seek you out to talk about their issues or concerns?)
Yes
No
12.

How do you handle disagreements?
 

  • 350 characters left.
13.

Do you anger easily on civil rights issues?
Yes
No
14.

Although  there is NOT an education requirement to participate in this training, please share with us your educational background.
 

  • 350 characters left.
15.

Are you willing and available to travel to speak to groups in your geographical area?
Yes
No
16.

Have you ever been convicted of a crime?  If so, please list.
Yes
No
  • Comment:

  • 500 characters left.
17.

This training offers a basic foundation for assisting families but are you willing to participate in other trainings that might be required in order to remain a member of the Parent Leadership Institute?
Yes
No
18.

What is your current occupation?
 

  • 350 characters left.
19.

Please enter your contact information below.  Name and Email address are required for notification of future trainings.  A physical mailing address may be required for the distribution of some training materials.


By entering my personal information, I consent to receive email communications from the survey author's organization based on the information collected.

First Name:
Middle Name:
Last Name:
Job Title:
Company Name:
Work Phone:
Home Phone:
Email Address:
emailaddress@xyz.com
Address 1:
Address 2:
Address 3:
City:
State/Province
(US/Canada):
Postal Code:

20.

Are there any specific issues you would like to have addressed during this training?  If so, please list.
Yes
No
  • Comment:

  • 500 characters left.

Additional details on future trainings will be sent to you when available.