2006/2007
VISION HCP
Educational Survey
LearnerÕs
Name______________________________________________ Date
__________________________
Number of
years in VISION program __________
From the
LearnerÕs perspective:
How many
meaningful relationships do you have that support your education? _________
For your age
level, rank your confidence in: (5 being very confident and 1 being no
confidence)
Reading 1 2 3 4 5
Writing 1 2 3 4 5
Math 1 2 3 4 5
Social
Skills 1 2 3 4 5
Creative
Expression 1 2 3 4 5
How would
you score last yearÕs education? 1 2 3 4 5
Terrible
Excellent
Do you think
you learned what you needed to learn? 1 2 3 4 5
Not
at all
Completely
How excited
are you about learning? 1 2 3 4 5
Not
at all
Very
Circle those
statements that are true:
1.
I feel
supported in my education.
2.
I feel
confident about my education.
3.
I feel
that my education is meaningful.
4.
I feel
school supports me and encourages me to follow my own desires.
5.
I do
school only because I have to.
6.
I love
to learn.
7.
I feel
that what IÕm learning is relevant and useful.
8.
I am
bored with school.
How often do
you set your own educational goals and then try to achieve them?
1 2 3 4 5
Never Often
How
supported do you feel in your educational effort for your child?
1 2 3 4 5
Not
at all
Very
How
confident are you about educating your child? 1 2 3 4 5
Not
at all Very
How involved
do you feel in your childÕs education? 1 2 3 4 5
Not
at all Very
How pleased
are you with the education your child received last year?
1 2 3 4 5
Not
at all
Very
The number
of meaningful relationships that you perceive in your childÕs life that support
his or her education: _____________