Student Profile: Student Form

Name: ____________________ Date of Birth:_________

School: _____________________ Phone:___________

Grade Level: ___________ Date Completed:_________

1. I am interested in:
   
2. Things I want to learn:
   
3. I am best at:
   
4. I need most help with:
   
5. Help I have received in the past:
   
6. Problems with my current program:
   
7. Possible alternatives and/or additions to my current program:
   
8. Support services that I need:
   
9. Special concerns I have:
   
10. Suggestions I have about working with me:
    
11. My strengths in the area of:
    
    • Academics:
      
    • Speech:
      
    • Motor:
      
    • Social/Behavior:
      
    • Vocational/Prevocational:
      
    • Self-Help:
      
    • Self-Advocacy Skills:
      
12. Concerns I have in the following areas:
    • Academics:
      
    • Speech:
      
    • Motor:
      
    • Social/Behavior:
      
    • Vocational/Prevocational:
      
    • Self-Help:
      
    • Self-Advocacy Skills:
      
13. When I leave high school as a young adult, I expect: