1.

Are you familiar with specific State legislation regarding privacy and records transfer?

Yes/No

List key State legislation:

Are you familiar with your State's transition plan?

Yes/No

List key guidance beyond State Part D transition plan:

How often is your facility monitored by the State?

Every ____ months/years

Additional opportunities for technical assistance and evaluation (e.g., surveys, conferences):

Does your facility have a formalized transition/records transfer procedure?

Yes/No

Does your facility have a transition coordinator?
List this person's responsibilities:

Yes/No

Who is directly responsible for records transfer in your facility?
(e.g., Is this person your transition coordinator?)

What is the number/percentage of students with educational records from previous placements/schools?

Total ____
____%

What is the average number of days between student arrival and student records request?

____ days

What is the average number of days between student records request and receipt?

____ days

Do you record student information in the following areas:

(a) Mental health?

Yes/No

(b) Physical health?

Yes/No

(c) Special education status?

Yes/No

(d) Reading achievement?

Yes/No

(e) Math achievement?

Yes/No

(f) Coursework completed?

Yes/No

(g) Credits earned?

Yes/No

(h) Grades?

Yes/No

(i) Vocational skills?

Yes/No

(j) Student goals?

Yes/No

How often are student records updated?

Every ____ months/years

How are updates accomplished? (e.g., meetings with teachers/counselors/transition coordinator, progress monitoring assessments)

Who is responsible for updating student records? (e.g., Is this person your transition coordinator?)

How many students (number/percentage) leave the facility with updated records?

Total ____   ____%

Average number of days to transfer student records to next placement?

Total ____   ____%