Pupil Assistance Committee Faculty Survey

Please complete the following survey regarding PAC processes. PAC Committee and I will use the results of the survey to plan our October staff meeting. Thank you for your prompt attention.



  1. Where can you find the PAC Referral form?
    What referral form?
    In the Main Office
    In the Guidance Office
    On line
    In your teacher's handbook


  1. Have you ever used the PAC Strategy binder for information or ideas?
    Yes
    No
    What Strategy binder?


  1. There are five core members of the PAC team who attend every meeting. List the names of the members that you know.


  1. Where is the binder that contains PAC and 504 plans from the last two years.


  1. Should a student be referred to PAC for an academic concern before he/she is referred to the ESST (Elementary Student Support Teacher)?
    Yes
    No


  1. Place the following procedures in the appropriate order according to when they should occur. Please number the items from 1 to 5 (1 being first and 5 last).
        1 2 3 4 5
    Turn in a completed PAC referral form.  
    Refer student to Child Study Team.  
    Notify ESST that a students is academically "at promise."  
    Contact the parents/guardians about your PAC referral.  
    Document "at promise" information in the student's computer file.  


  1. Does a student need to be classified to have a 504 Plan?
    Yes
    No


  1. What is the purpose of the Pupil Assistance Committee?


  1. What type of information must be gathered and procedures followed before a student is referred to the Child Study Team?


  1. Please type any questions you have about PAC-504 plans or procedures in the space below.