Interview Questions
Intake Questionnaire for Students Who Are Blind or Visually Impaired
Student Name ________________________________________
- Are you an individual with vision impairment, or are you blind?
- If a degree of vision impairment, jump to question #4. If blind, continue with #2.
- Have you been blind since birth?
- If no, when and how did you experience vision loss?
- Do you use any special visual aids? Do you use a dark pen or
dark-lined paper? - What size print can you read comfortably? (Have a few samples available.)
- How long can you read print before experiencing eyestrain?
- Are you able to read print from the blackboard comfortably?
- Does glare keep you from seeing objects correctly?
- Are you able to write and read back what you’ve written?
- Can you see colors? What color or type of background helps make objects easier to see?
- Do you have any other disabilities that may interfere with your ability to learn? (hearing impairment, head injury, diabetes, etc.)
- Do you have someone to help you at school and/or at home?
- How do you usually read? (regular print, large print, Braille, or cassette tape)
- If you read Braille, when and where did you learn it?
Do you read Grade 1 or 2? - How do you plan to take notes? (paper and pencil, slate and stylus, laptop, Notetaker, Perkins Brailler, tape recorder or other)
- Do you have experience using a computer or JAWS?
- How many years of schooling did you complete? Where did you attend school and what were your favorite subjects? How were your grades/marks? Did you receive a diploma or similar?
- What languages do you speak at home? What languages do you know how to read and write?
- Why do you want to come to our program/school?