EDLC 510

Interview Assignment Template – Questions for Student or Parent

Interviewer, you may type the interview responses directly onto this template.

First name or initials of interviewee:

Age of individual discussed in the interview:

Relationship to the individual with special needs:

Description of the individual’s special needs, including:

· Name of condition, syndrome, or disorder

· Physical challenges

· Intellectual challenges

· Emotional challenges

· Social challenges

Equipment, therapies, additional support needed to address the individual’s unique needs:

Activities the individual enjoys. Include a description of any adaptations required for the individual to be able to participate in these activities.

Does this individual require additional care (education, physical, entertainment)? If so, what skills are required of the caretaker(s)?

How has your life been impacted by the special needs of this individual?

Student choice question: Create your own question for the person you are interviewing. Erase this line and type your question in its place.

After you have completed the interview, you will write a 200-word summary of what you learned from the interview and a 300-word conclusion. The conclusion must include citations from at least one scholarly resource and the course textbook. A reference page should be included. The interview template, summary, and conclusion should be submitted in one document.