| Program Visit Feedback Form* |
| Date of Visit: _________________ School Visited:_________________________ Name of Program: ______________ District: _____ Phone: ________________ Address: _______________________ Contact Person: _______________________ Based on your observations, please “X” the appropriate space: How many children were in the class? _____ How many staff adults were in the class? _____ (teachers), _____ (assistants) The staff was enthusiastic with the students: The staff engaged students in activities: The classroom had adequate space: The classroom was well organized: The classroom had light and was clean: The classroom had a variety of toys: The classroom had a variety of books: The classroom had additional learning tools (i.e. computer): The children were involved in learning activities: The program used PECS: The program used TEACCH methods: The program used discrete trials: The program used visual cues: I would be comfortable having my child in this classroom: I was welcomed to contact parents of children in the program, to discuss the progress of their child. The program offered services in the following languages: _____________________________________________________________________ _____________________________________________________________________ Comments: __________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ Note: Parents of children attending the Birch W. Queens STEPS program, are encouraged to fill the following attachment, and to revise our data base of forms filled by parents and staff. For hard copies of the form, please feel free to contact the social worker of your chil'd classroom. Visitor’s name _____________ Status: Parent [ ], BWQ Staff [ ], other [ ] Language(s) spoken: ___________________________________________________ I invite families to contact me regarding the CSE process: yes ___, no ___ Phone (optional): _________________ Best time to call: ___________________ Created in the year 2000 by Columbia University social work trainees at H. G. Birch Western Queens. |
| yes __________, no __________ yes __________, no __________ yes __________, no __________ yes __________, no __________ yes __________, no __________ yes __________, no __________ yes __________, no __________ yes __________, no __________ yes __________, no __________ yes __________, no __________ yes __________, no __________ yes __________, no __________ yes __________, no __________ yes __________, no __________ yes __________, no __________ |
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