Name (optional):
Program/District/Agency:
I am a:
Parent
Teacher
Instructional Aide
Administrator
When did you or your learner(s) begin receiving services under the Competent Learner Model (CLM)?
Have you attended a presentation describing the Competent Learner Model (CLM) (e.g., IntroUnit)?
Yes
No
If so, please tell us roughly when:
Have you attended an IEP for your learner receiving
services under the Competent Learner Model (CLM)?
Yes
No
Have you ever been enrolled in the Course of Study (CD’s)?
Yes
No
If yes, please tell us the last Unit you have completed:
Are the CLM training modules (CDs)…
easy to use?
Yes
No
Somewhat
I don't know
interesting?
Yes
No
Somewhat
I don't know
useful?
Yes
No
Somewhat
I don't know
Do you feel that you have been given an ample explanation of the Competent Learner Model (CLM)?
Yes
No
Somewhat
I don't know
If not, please write what would you like clarification or information on:
Do you feel that the Competent Learner
Model (CLM) is an appropriate program
for your learner(s)?
Yes
No
Somewhat
I don't know
Do you feel that the Competent Learner
Model (CLM) is an effective program for
your learner(s)?
Yes
No
Somewhat
I don't know
Do you feel that the skills addressed in
the CLM are meaningful to your learner(s)?
Yes
No
Somewhat
I don't know
Do you feel that the goals addressed in
the CLM are appropriate for your
learner(s)?
Yes
No
Somewhat
I don't know
Do you feel that the instructional
methods addressed in the CLM are effective
for your learner(s)?
Yes
No
Somewhat
I don't know
Administrators Only (parents and staff please see below):
Does the CLM “make sense” to you in
terms of its’ organization, content, goals, cost
and effectiveness?
Yes
No
Somewhat
I don't know
Does the CLM provide you with the kind
of overall program control, oversight and
accountability that you need in order to make
important decisions about special or general
education services in your
program/district/agency?
Yes
No
Somewhat
I don't know
Has or might the CLM contribute to the
reduction of special or general education
costs?
Yes
No
Somewhat
I don't know
For Parents, Teachers and Aides:
Please tell us whether you feel each of the repertoires or skills below may attribute to a learner’s
overall success :
observing (e.g., sort, imitate, label)
Yes
No
Somewhat
I don't know
problem solving (e.g., ask, manipulate)
Yes
No
Somewhat
I don't know
participating (e.g., teacher-directed)
Yes
No
Somewhat
I don't know
listening (follow directions or advice)
Yes
No
Somewhat
I don't know
talking (repeat rules, answer questions)
Yes
No
Somewhat
I don't know
reading (decode words, comprehends)
Yes
No
Somewhat
I don't know
writing (copy text, write sentences)
Yes
No
Somewhat
I don't know
Do you think that the CLM addresses academically important behaviors such as
learning in small and large groups, learning to
learn by observing other people, etc.?
Yes
No
Somewhat
I don't know
Do you think that the CLM addresses
functionally important behaviors such as
washing hands, toileting, eating skills, etc.?
Yes
No
Somewhat
I don't know
Does the implementation of the CLM
meet your expectations for how you want
your learner(s) to be taught?
Yes
No
Somewhat
I don't know
Do you feel you have adequate
involvement in the implementation of the
program?
Yes
No
Somewhat
I don't know
Does the way the CLM is managed allow
you to stay informed about your learner(s)’s
educational/behavioral program?
Yes
No
Somewhat
I don't know
Does the CLM “make sense” to you?
Yes
No
Somewhat
I don't know
For Parents:
What supplementary service(s) is your child
receiving (please check all that apply)?
CLM at School
O.T.
1:1 Speech
Resource
Parent Training
Shadow Aide
CLM at Home
A.P.E.
Small Group Speech
Inclusion
For Teachers:
Are the following aspects of the CLM acceptable to you?
curriculum goals/objectives
Yes
No
Somewhat
I don't know
teaching procedures
Yes
No
Somewhat
I don't know
academic content
Yes
No
Somewhat
I don't know
Are the following aspects of the CLM valuable to you?
curriculum goals/objectives
Yes
No
Somewhat
I don't know
teaching procedures
Yes
No
Somewhat
I don't know
academic content
Yes
No
Somewhat
I don't know
Is the CLM Curriculum written so you
readily understand how to teach a learner(s)
so you can achieve a goal?
Yes
No
Somewhat
I don't know
Does the CLRA help you write meaningful
and appropriate IEP goals & objectives?
Yes
No
Somewhat
I don't know
Does the CLRA help you write district
appropriate (i.e., State Standards referenced)
IEP goals & objectives?
Yes
No
Somewhat
I don't know
If not, please tell us why the
CLRA is not helpful to you:
Does the CLM address developmentally
important behaviors?
Yes
No
Somewhat
I don't know
Does the CLM address socially important
behaviors?
Yes
No
Somewhat
I don't know
Does the CLM address academically
important behaviors?
Yes
No
Somewhat
I don't know
Does the CLM address functionally
important behaviors?
Yes
No
Somewhat
I don't know
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