Family Name  * required Date  * required Preschool Program  * required Are you a parent, teacher or supervisor?  * required 1.  Is your Resource Teacher punctual? Always Sometimes Never

2.  Does she provide you with a schedule for each of the following:

Home Visits No Yes Scheduled School Visits No Yes Team Meetings No Yes

3.  Did your Resource Teacher discuss with you the services offered at the time you became involved with HDCCPC's Integration Program, (i.e. home visits, schedule of school visits, team meetings)?

Yes No

4.  Did you meet regularly with your Resource Teacher to discuss your child's progress? (team meetings, home visits)

Yes No Weekly Bi-weekly Monthly Never Rarely

5.  Is assessment information shared with you? Always Sometimes Never 6.  Does your Resource Teacher support and encourage you in communicating with all team members? Always Sometimes Never 7.  Does your Resource Teacher provide you with appropriate resources? Always Sometimes Never 8.  Does your Resource Teacher display a sense of professionalism, (i.e. dress code, confidentiality, limiting personal conversation, professional boundaries)? Always Sometimes Never 9.  How could we improve our services? 10.  What did we do well? 11.  Would you like the Program Coordinator to contact you regarding this survey? Yes No