Name:		
Date of Birth	

1. Please describe your speech and language difficulties:






2. When did you leave school?






3. Which school did you attend?






4. Did you receive support with your difficulties at school? 
(yes or no)		

      If you did, what kind of support?


      


5. Did you go to FE College after school?

(yes or no)		 



      If you did, What course did you do?


       


      Did you receive support for your language difficulties?


       


      Did you receive a certificate?
(yes or no)		 

      If so, what?


       



6. Have you been involved in a Youth training programme?
(yes or no)               

      If so, please give details


       



7. Have you been on a work placement?
(yes or no)		 

      If so, was this
 


      At school? (please give details)
       


      Through College? (please give details)
       



      As part of a training scheme? (please give details)
       




8. Have you done any voluntary work ? (please give details)


       





9. What support have you had from Careers Scotland?


       






10. How many jobs have you applied for?


	           	 


11. How many interviews have you had?


	           	 


12. Were any of the applications successful?


	           	 


13. If you have had a job, was it a temporary job?

    
(yes or no)          


14. If the job was not a temporary one, how long did it last?

 
	           	 






Please add any other information you wish us to take into consideration: For example any other agency  you’ve been involved with (Fenlink) (Social Work)


       





 

 
Thank you for taking the time to give us this information.  
We cannot promise that anything special will happen as a result of this survey but it will help us to 
understand what is happening to young people with Speech and Language Impairments in Scotland.


 
(click once)
 




THIS INFORMATION WILL GO TO:
Afasic Scotland, 1, Prospect 3, Gemini Crescent, Dundee 
Technology Park , Dundee, DD2 1TY
Tel: 01382 561891 Fax: 01382 568391 

Email: info@afasicscotland@.org.uk
Website: www.afasicscotland.org.uk