Dear Parents:

The Archdiocese of Chicago has long recognized the great need for a faith based, safe, and nurturing environment for cognitively disabled adolescents. We are in the process of collecting data for the purpose of creating a unique secondary program to address these needs. This survey will provide the critical data needed to access necessary funding.

Please respond to this survey and know that your information will remain confidential.

Sincerely,
Leah Duszynski
Director of Inclusive Education
312-751-3893

1) Describe the services that your child is currently receiving in his/her present school.   2) What high school do you plan on sending your child to?   3) Do you have concerns about this high school placement? Safety? Curriculum? Social interactions?
Please explain.  

4) If the Office of Catholic Schools were to open an innovative high school program for cognitively disabled adolescents, how interested would you be in this program?

Please rate on a scale of 1 to 4, with 1 being not interested and 4 being very interested.

1 2 3 4  

5) If the Office of Catholic Schools were to open a high school program for cognitively disabled adolescents, how interested would you be in sending your special needs child to a tuition-based program?

Please rate on a scale of 1 to 4, with 1 being not interested and 4 being very interested.

1 2 3 4  

6) How interested would you be in this program if tuition assistance were available?

Please rate on a scale of 1 to 4, with 1 being not interested and 4 being very interested.

1 2 3 4  

We may wish to contact you for follow-up information. Would you be willing to include your contact information?

Name:

Phone:

E-mail: