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Student Profile: Student Form

(1999)

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: