GENERAL INSTRUCTIONS *All information requested is for the school year 1962-63. In published reports the facts and opinions obtained on these forms 1. Were blind children instructed in your school last year? Yes 2. Were partially seeing children instructed in your school last year? Yes 3. Did your school serve visually handicapped children who also had other types of handicaps? Yes handicaps. No, served only those without additional If yes, please check below the types of additional handicaps served: a. Deaf b. Hard of hearing c. Upper range mentally retarded (IQ approx. 50 to 70) d. Middle range mentally retarded (IQ approx. 25 to 50) e. Speech impaired f. Crippled (orthopedic) g. Socially maladjusted (including delinquents) h. Emotionally disturbed i. Special health problems (tuberculosis, cardiac, epilepsy, etc.) j. Other (please specify) 4. Did you have a waiting list of blind and/or partially seeing children of school age who were known to be eligible for and in need of special instructional services but who could not be included in your program because of limited facilities or staff? Yes If Yes, how many children did you have on your waiting list in each of the following classifications? a. Blind b. Partially seeing c. Either blind or partially seeing but not yet separately classified d. With major second handicaps in addition to either blindness or partial vision 5. During the 1962-63 school year what was the average teacher-pupil ratio in each grade level and type of class listed below? (Report ratios only for classes organized for academic instruction. Do not report ratios for pupils in special classes for art, physical education, music, speech correction, etc.) Example: For two classes of partially seeing children in elementary grades, one teacher having 12 pupils and the other 8, the total number of children (20) divided by the number of their teachers (2) results in a teacher-pupil ratio of 10 which should be entered in the third column, line a. below. 6. Please circle below the lowest and highest grades which your school program was organized to serve. (Report types of children served-blind or partially seeing-according to the way in which you group or assign them for instructional purposes.) a. Both blind and partially seeing instructed in combination units: Nursery, kindergarten, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14 b. Blind only: Nursery, kindergarten, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14 c. Partially seeing only: 7. Were pupils in your school known to State or local governmental crippled children's programs? a. Yes, blind. Approximately how many? b. Yes, partially seeing. Approximately how many? 8. a. How many children in your school regularly attended some classes in local public schools during the 1962-63 school year? 1. Blind 2. Partially seeing 3. Please circle below the lowest and highest grades in which these pupils were enrolled: a. Blind: Nursery, kindergarten, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14 b. Partially seeing: Nursery, kindergarten, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14 b. During approximately which year was the practice of having some pupils attend classes in local public schools started and, if applicable, when was it discontinued? 1. Blind: Started 19 Discontinued 19. _, Discontinued 19. 2. Partially seeing: Started 19 9. Are eye examination reports from qualified eye specialists required for pupils being considered for participation in your school program for blind and/or partially seeing children? Yes If Yes, how recently must this examination have been performed? a. One year or less prior to application b. More than one year prior to application 10. Are eye examination reports from qualified eye specialists required for pupils already participating in your special program? Yes If Yes, how often are these examinations required? b. Semiannually or more frequent regular interval c. Only when change in eye condition or visual acuity is detected d. Only as recommended by examining eye specialist e. Other (please specify). 11. Please check below each of the factors which you consider important in determining pupil eligibility for participation in your program for visually handicapped children. Important for Blind Partially seeing Pupil performance a. The child has limited vision and is unable to make satisfactory progress in a regular general school program. b. He is unable to see well enough to read print in regular school C. texts. He is unable to see well enough to read large print books satisfactorily. d. Other performance factors (please specify). e. Advice of Experts A special teacher of visually handicapped children in your program recommends acceptance of the child. f. The administrator or supervisor of your special program recommends placement in your program. g. The examinining eye specialist recommends placement in your j. Visual acuity is 20/40 or less in better eye with glasses. 0. p. Child has sufficient vision to make significant use of it in school. q. Child has defective visual fields. r. S. Other visual factors (please specify). Other physical and psychological factors Child must have average or above average intelligence. t. He must have sufficient intelligence to be considered educable (I.Q. approximately 50 or more). u. He must have sufficient emotional stability to be considered educable. v. He must have no major physical disability in addition to the visual limitation or less. w. Other physical or psychological factors (please specify). Other factors you consider important x. (please specify). 12. Which one of the following do you generally use as a basis for determining that a child with very limited vision is to be classified and educated as partially seeing rather than blind? a. The degree of his corrected visual acuity b. The ability to use regular or large print instead of braille as an important mode of reading c. Other basis (please specify) 13. Which of the following procedures do you use to help determine whether a child with very limited vision will be able to read more satisfactorily by means of braille or print? (Check the one procedure most often used under each grade level listed.) TABLE I.-Number and percent of local school programs, by type of organizational pattern and by type of visual handicap served, United States: 1962-63 1 Percentages do not total 100 since some programs use the same organizational pattern to serve different types of visually handicapped children. |