The madison social relationship inventory


The Array of Extracurricular Activities



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The Array of Extracurricular Activities

Record the extracurricular activities in which the student is involved throughout the current school year or examine the Current Extracurricular Activity Chart.


Is the array of extracurricular activities in which the student participates across the school year acceptable?
Yes
No

If "Yes," report why the array of extracurricular activities in which the student participates across the school year is acceptable.



If "No," report why the array of extracurricular activities in which the student participates across the school year is unacceptable.

Are there extracurricular activities in which the student could or should participate, but does not?
Yes
No

If "Yes," report the extracurricular activities in which the student could or should participate and the reasons why.





Current Extracurricular Activity #1
Time - The amount of time per week the student typically participates in Current Extracurricular Activity #1 is .
Is the amount of time per week the student participates in Current Extracurricular Activity #1 acceptable?
Yes
No

If "Yes," report why the amount of time per week the student participates in Current Extracurricular Activity #1 is acceptable.


The student participates in Extracurricular Activity #1 the same number of months per year she/he would if not disabled.
The student participates in Extracurricular Activity #1 the same number of days per week he/she would if not disabled.
The student participates in Extracurricular Activity #1 the same number of hours per week he/she would if not disabled.
The student participates in Extracurricular Activity #1 for the same amount of time per meeting she/he would if not disabled.

If "No," report why the amount of time per week the student participates in Current Extracurricular Activity #1 is unacceptable.

Persons With Whom The Student Interacts - Record the persons the student interacts with in Current Extracurricular Activity #1.
Schoolmates with disabilities
Schoolmates without disabilities

Instructional assistant
Special education teacher
Adult activity leader
Supportive companion
Regular education teacher
Coach



Is the array of persons with whom the student interacts in the Current Extracurricular Activity #1 acceptable?


Yes
No

If "Yes," record why the array of persons with whom the student interacts in the Current Extracurricular Activity #1 is acceptable.


The student interacts with the same array of persons he/she would interact with if not disabled.

If "No," record why the array of persons with whom the student interacts in the Current Extracurricular Activity #1 is unacceptable.
He/she only interacts with adults.
She/he only interacts with professionals.
He/she never interacts with nondisabled schoolmates.
She/he interacts with too many others who are disabled.

Report those persons with whom the student should interact while participating in Current Extracurricular Activity #1, but does not.
Schoolmates without disabilities
Coach
Adult activity leader
Supportive companion




Supervision

Record the adults responsible for supervising the student while he/she participates in Current Extracurricular Activity #1.


Adult activity leader
Educational assistant
Special education teacher
Occupational therapist
Volunteer
Coach



Are the persons responsible for supervising the student as he/she participates in Current Extracurricular Activity #1 acceptable?


Yes
No

If "No," report why the persons responsible for supervising the student while he/she participates in Current Extracurricular Activity #1 are unacceptable.


Report the adults who should supervise the student in Current Extracurricular Activity #1, but do not.


Adult activity leader
Coach




Extra Support

Extra support refers to the PERSONNEL, INFORMATION-TRAINING, INDIVIDUALIZED ADAPTATIONS, MONEY and OTHER phenomena a student and those who interact with her/him need in order to function acceptably in integrated extracurricular activities, THAT WOULD NOT BE NEEDED IF HE/SHE WAS NOT DISABLED. In reality, it is often difficult or impossible to delineate mutually exclusive categories of support. However, for organization and communication purposes it seems necessary here.


Record the PERSONNEL who provide support while the student participates in Current Extracurricular Activity #1 who would not provide it if he/she was not disabled.
Special education teacher
Instructional assistant
Occupational therapist
Physical therapist
Volunteer
Supportive companion



Are the extra PERSONNEL who provide support while the student participates in Current Extracurricular Activity #1 acceptable?


Yes
No

If "No," report why the extra PERSONNEL who provide support while he/she participates in Current Extracurricular Activity #1 are unacceptable.


He/she receives more supervision from adults than is actually needed.
The presence of an "aide" segregates her/him from nondisabled peers.

Report the PERSONNEL who should provide support while the student participates in Current Extracurricular Activity #1, but do not.

In some instances those who interact with the student may be in need of INFORMATION and/or specific kinds of TRAINING. A soccer coach may need specific information about behavior management strategies; a supportive companion may need INFORMATION about the procedure to follow if a breathing tube becomes clogged, etc.

Record the extra INFORMATION-TRAINING that has been provided those who interact with the student while he/she participates in Extracurricular Activity #1.



Is the extra INFORMATION-TRAINING that has been provided those who interact with the student while he/she participates in Current Extracurricular Activity #1 acceptable?
Yes
No

Is there INFORMATION-TRAINING that should be provided those who interact with the student in Current Extracurricular Activity #1?


Yes
No

If "Yes," report the INFORMATION-TRAINING that should be provided and who should receive it.



Record the INDIVIDUALIZED ADAPTATIONS used in Current Extracurricular Activity #1.

Are the INDIVIDUALIZED ADAPTATIONS used in Current Extracurricular Activity #1 acceptable?
Yes
No

If "No," report why the INDIVIDUALIZED ADAPTATIONS being used in Current Extracurricular Activity #1 are unacceptable.


The adaptations currently being used do not work properly.

Are there INDIVIDUALIZED ADAPTATIONS that might enhance the functioning of the student in Current Extracurricular Activity #1?


Yes
No

If "Yes," describe the INDIVIDUALIZED ADAPTATIONS that might enhance the functioning of the student in Current Extracurricular Activity #1 and how each might be used.



Record any OTHER extra support provided Current Extracurricular Activity #1.



Is the OTHER extra support provided Extracurricular Activity #1 acceptable.
Yes
No
If "No," report why the OTHER extra support provided Extracurricular Activity #1 is unacceptable.

If OTHER extra support should be provided Extracurricular Activity #1, report it below.



Record the total amount of MONEY spent on Current Extracurricular Activity #1.
Is the total amount of MONEY spent on Current Extracurricular Activity #1 acceptable?
Yes
No

If "Yes," report why the total amount of MONEY spent in relation to Current Extracurricular Activity #1 is acceptable.


The total cost is about the same as it would be if the student was not disabled.
Extra personnel are required to provide the instruction necessary for the student to participate more. However, this instruction will allow her/him to be more proficient and less costly in the long run.

If "No," report why the total amount of MONEY spent in relation to Current Extracurricular Activity #1 is unacceptable.


The cost of paying professionals to assist the student could be reduced if the proper adaptations were utilized.
Parents cannot afford the costs.



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