The
complete resource to help parents and professionals include ALL kids in summer camp
Special
Needs Program Pre-Staff Survey
Name_______________________________________________________________________________
Position_____________________________________________________________________________
Directions: Please
circle the extent to which you agree or disagree with each statement. Please add
additional comments/explanations.
SD= Strongly
Disagree; D= Disagree; U= Uncertain; A= Agree; SA= Strongly Agree
SD D U A SA
1. I think
individuals with disabilities can benefit from 1 2 3 4 5
inclusion into
camp?
I
think they can benefit in which of the following areas:
• Self-Concept 1 2 3 4 5
• Enjoyment 1 2 3 4 5
• Social Interaction 1 2 3 4 5
• Independence 1 2 3 4 5
• Appropriate Behavior 1 2 3 4 5
• Motor Skills 1 2 3 4 5
Other
2. I
think peers without disabilities can benefit from 1 2 3 4 5
the inclusion of
children with disabilities?
I
think they can benefit in which of the following areas:
• Learning about individual differences 1 2 3 4 5
• Acceptance of others with a disability 1 2 3 4 5
• Self-concept 1 2 3 4 5
• How to interact with someone with a
disability 1 2 3 4 5
Other
3. I
feel that peers without disabilities will socialize with 1 2 3 4 5
individuals with
disabilities free of adult intervention?
Directions: Please
circle the extent to which you agree or disagree with each statement. Please add
additional comments if you have them.
SD= Strongly Disagree;
D= Disagree; U= Uncertain; A= Agree; SA= Strongly Agree
SD D U A SA
4. I
feel that peers without disabilities will be:
• Friends 1 2 3 4 5
(people with whom the individual has a
mutual, and
reciprocal relationship spending time and sharing experiences
during camp)
• Acquaintances 1 2 3 4 5
(Person who has a brief impersonal interactions by
planned or chance encounters during
camp)
• Service Provider 1 2 3 4 5
(People for whom the relationship is
based on an obligation
to provide interaction and services
with individuals with disabilities?
5. I think inclusion might interfere with
activities 1 2 3 4 5
at Camp/Center?
Explain:
6. I
have fears and concerns about the inclusion
of 1 2 3 4 5
individuals with
disabilities at Camp/Center.
Explain:
7. At
this time, which statement would most accurately reflect your outlook regarding
inclusion at Camp/Center? (Please check
one)
_____ I have many reservations about how
inclusion will work.
_____ I
am mildly concerned about how inclusion will work.
_____ I
am not sure how inclusion will work.
_____ I
look forward to the inclusion of individuals with disabilities and helping to
make it work.
_____ I
am excited about inclusion and feel everyone will benefit from the experience.
8. Please describe your previous exposure or contact with persons with disabilities either as a volunteer, sibling, friend or paid staff.
9. Do
you have any special skills or training to work with individuals with
disabilities (know sign language, coursework)?
10.
Additional Comments:
Please, do not hesitate to ask questions
about individuals with disabilities; a question unanswered leaves a little fear
of the unknown inside..... preventing communication.....which prevents
inclusion!
THANK YOU!
Brad Gilbertson, Special Needs Director
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