Critical School Events (high school) (Parent)

OMB No: Exp Date:

Parent Critical Events Form High School
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We would like to learn how your child’s school year is going and about any problem(s) he/she is experiencing. Also, we would like to know about any contact and communication you have had with your child’s school.
1. Enrollment A . Is your child currently enrolled in high school? Yes No B. Is your child currently attending college? Y es No C. When was the last time your child attended school: Month: _____ Year_____ D. What was the last grade your child attended: _________ E. Did your child pass that grade? Yes No F. Did your child get a high school diploma? Yes No G. Did your child get a GED or equivalent? Yes No	H. Here are some reasons other people have given for leaving school. Which of these would you say apply to your child? Your child: (check all that apply) Got a job Didn’t like school Couldn’t get along with teachers Couldn’t get along with other students Was pregnant Became the father/mother of a baby Had to support his/her family Was suspended from school Did not feel safe at school Had to care for a member of his/her family Was expelled from school Felt he/she didn’t belong at school Couldn’t keep up with schoolwork Was getting poor grades/failing school Got married or planned to get married YES/NO Changed schools and didn’t like the new school Couldn’t work and go to school at the same time Thought he/she would not pass the state competency test Thought he/she would not be able to complete the high school coursework requirements Thought it would be easier to get a GED Missed too many school days I . On the whole, does your child feel that leaving school was a good decision for him/her? Yes No Don’t Know

Public reporting burden of this collection of information is estimated to average 4 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Clearance Officer; 1600 Clifton Road NE, MS D-24, Atlanta, Georgia 30333; ATTN: PRA (???).

3. Detentions A . Has your child been in detention this school year? Yes No Don’t Know B. If YES, How many different times was he/she in detention? _____ times C. Can you tell me why your child was put in detention? Behavioral Problems Academic Problems Other Problems Don’t Know 4. Transfers A . Has your child changed schools this school year? Yes No Don’t Know B. How many times has he/she changed schools this school year? _____ times C. Why did your child change schools? Family moved Child expelled Zoning changes Overcrowded classes/child did not receive attention Other Don’t Know

5. 504 Plan A . Does your child have a 504 Plan for this school year? Yes No Don’t Know B. Can you tell me about your child’s 504 plan? (What changes have been made for him/her?) ______________________________________________________ C. Can you tell me why your child has a 504 plan? Behavioral Problems Academic Problems Other Problems Don’t Know 6. IEP Plan A . Does your child have an IEP Plan for this school year? Yes No Don’t Know B. Can you tell me about your child’s IEP plan? (What types of changes have been made for him/her?) ___________________________ C. What type of program is it? Regular classroom Resource room Alternative school Other: ___________________________

D. Can you tell me why your child has an IEP plan? Behavioral Problems Academic Problems Other Problems Don’t Know 7. Resource/Special Ed A. Is your child in any resource or special education classes this school year? Yes No Don’t Know B. How many hours per week is he/she in a resource or special education class? ________ #hrs/week C. Can you please list the resource or special education classes that your child takes? ______________________________________________________