Thank you for taking the time to complete this questionnaire.  Your responses will assist us in planning for the workshop.


1.  Please list the daily schedule of activities for the classroom:




























2.  During which activities is Daniel’s behavior most appropriate (i.e., he is most engaged, attentive, and meeting the expectations of the activity):


3.  During which activities is Daniel’s behavior least appropriate?


                a.  Please briefly describe the inappropriate behaviors Daniel demonstrates during these activities:


                b.  How often do the inappropriate behaviors occur?


                c.  How severe are the inappropriate behaviors ?  (i.e., how much do they interfere with Daniel’s learning experience or the learning of the other children?)


4.  What approaches have you tried to change this behavior?  (We appreciate as much detail as you can provide on this question.)


5.  How do the teachers let the children know when it is time to change activities (transition)?


6.  Please describe Daniel’s behavior during transitions:


                a.  Are there particular transitions which are more difficult for him than others?


                b.  Are there particular transitions which are easier for him than others?


7.  Are there any children in the classroom with whom Daniel is particularly friendly?  If so, please:


                a. identify two or three children we can work with to help us to teach Daniel appropriate peer interaction


                b. identify 3-5 items or activities that these children might find rewarding


Name of Child

Things he or she likes to have or to do








8.  What specific areas or topics would you like to see addressed in the workshop?



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