Arkansas Child Find Awareness Campaign Evaluation
School District, Service Coordinator and
Educational Cooperative Survey
Tell us about the referrals you receive.
Did you receive referrals as a result of child find awareness activities?
Yes
No
Of the referrals you received, please identify the number for this year from each referral source.
Referral Source:
Community Agencies
Number of Referrals
How did they report learning about your program
Select option below
Television
Radio
Told By Someone
Printed Material
Referral Source:
Schools within your district
Number of Referrals
How did they report learning about your program
Select option below
Television
Radio
Told By Someone
Printed Material
Referral Source:
Parents
Number of Referrals
How did they report learning about your program
Select option below
Television
Radio
Told By Someone
Printed Material
Referral Source:
Physicians
Number of Referrals
How did they report learning about your program
Select option below
Television
Radio
Told By Someone
Printed Material
Referral Source:
Department of Human Services
Number of Referrals
How did they report learning about your program
Select option below
Television
Radio
Told By Someone
Printed Material
Referral Source:
School Based Parent Centers
Number of Referrals
How did they report learning about your program
Select option below
Television
Radio
Told By Someone
Printed Material
Referral Source:
Parent Training and Info. Centers
Number of Referrals
How did they report learning about your program
Select option below
Television
Radio
Told By Someone
Printed Material
Referral Source:
DDS Center
Number of Referrals
How did they report learning about your program
Select option below
Television
Radio
Told By Someone
Printed Material
Referral Source:
CHMS Center
Number of Referrals
How did they report learning about your program
Select option below
Television
Radio
Told By Someone
Printed Material
Referral Source:
Therapist
Number of Referrals
How did they report learning about your program
Select option below
Television
Radio
Told By Someone
Printed Material
Referral Source:
Individual in the Community
Number of Referrals
How did they report learning about your program
Select option below
Television
Radio
Told By Someone
Printed Material
Tell us about the Children you worked with.
Number of Children Screened
Private School
Highly Mobile Homeless
Grade to Grade
Highly Mobile Migrant
Highly Mobile Foster
Total
Number of Children Referred
Private School
Highly Mobile Homeless
Grade to Grade
Highly Mobile Migrant
Highly Mobile Foster
Total
Number of Children Evaluated
Private School
Highly Mobile Homeless
Grade to Grade
Highly Mobile Migrant
Highly Mobile Foster
Total
Tell us about the Arkansas Child Find Procedural Guide.
Do You have an Arkansas Child Find Procedural Guide?
Yes
No
Have you used the Arkansas Child Find Procedural Guide?
Yes
No
If no, please explain:
Did you find the Child Find Procedural Guide helpful in developing and implementing your Child Find Awareness Campaign?
Yes
No
What would you do to improve the Manual?