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Needs Assessment Form

Please note that submission of this online form is for trainings provided only through VCU T/TAC.

1. How often do you access email?
daily weekly less than weekly never

2. How often do you use the Internet to obtain information?
daily weekly less than weekly never

Click on the box next to each content area that you would like to learn more about or in which you would like to increase your skills.

assessment	motor	school safety
behavior	parent, family	transition, secondary
child find	feeding/oral motor	sensory
classroom management	IEP/IFSP/504 plan	transition, other
collaboration, team building	integration, LRE	social skills
communication/language	medical	technology (assistive)
curriculum, instruction	technology (instructional)	other:
disability characteristics	transition, preschool

Would you like to receive services that will increase your knowledge and skills?

to assist students with disabilities and those at-risk (birth to 9) to
have higher school completion and graduation rates

to use effective practices to improve performance of students with
disabilities and at-risk students (birth to 9)

to improve meaningful student/parent involvement

The T/TAC offers a variety of service delivery methods. Review the T/TAC services listed below; tell us whether you have used them, and how you think they could meet your needs.

Used it?	How could this service meet your needs?
Newsletter
Workshops, inservice, conferences
Technical assistance (consults)
Library
Technology Labs
Web site
Distance Learning
Work/interest groups

Long-term technical assistance project

Please tell us about yourself. Which instructional level(s) do you serve?

Early intervention

Preschool

Elementary

Middle

High

Post-secondary

School Division or Program Name:

In each of the 3 columns, check all that apply.

Type of Service Provider:	Program Affiliation:	Main Disability Area Served:
General Ed Adminstrator	Adult Ed & Family Literacy	ADD/ADHD
Special Ed Adminstrator	Early Childhood Special Ed	Autism
Guidance Counselor	Early Intervention	Deaf Blind
Human Service Agency Staff	Even Start	Deafness
Occupational Therapist	General Education	Developmentally Delayed
Other Related Service Provider	Head Start	Emotional Disturbance
Paraprofessional	Homeless Education	Hearing Impairment
Parent/Family	Migrant Education	Learning Disability
Physical Therapist	Occupational Child Care	Mental Retardation
Speech Pathologist	Preschool Initiative	Multiple Disabilities
Teacher, General Education	School Age Special Ed	Orthopedic Impairment
Teacher, Special Education	Title I	Other Health Impairment
Transition Coordinator	Other	Severe Disability
University Professor/Student		Speech/Language Impairment
Vocational Teacher/Administrator		Traumatic Brain Injury
Other		Vision Impairment

In the future, please offer trainings on these topics:

I like trainings that:

How else might the T/TAC be of assistance to you?

I need more information about:

VDOE Training and Technical Assistance Center @ Virginia Commonwealth University
Partnership for People with Disabilities | School of Education
Region 1: 10 E. Franklin St. - Suite 200, Richmond, VA 23219 (804) 828-6947
Region 8: Pickett Park, 440 QM Circle, Blackstone, VA 23824 (434) 292-3723
Copyright © 2008 VCU Training and Technical Assistance Center | Last Update: Monday, November 23, 2009