PERSONAL EXPERIENCE FORM

Date: ___________________________________ Time: ___________ - _____________

Interviewer: _____________________________________________________________

Individual Name: ______________________________________ Age ______________

Exceptionality/Disability: __________________________________________________

Individual/Parent Signature: ________________________________________________

See the second page for possible interview questions. You may certainly ask other questions that

are pertinent to your interviewee. Please include your additional questions so I can understand

how you answered the following summary questions.

Summary Interview Questions:

A. What did you learn about how individuals differ in their approaches to learning and

the barriers that impede learning?

B. What did you learn about how teachers can create instructional opportunities for

students with disabilities/exceptionalities?

C. What else did you learn about disabilities/exceptionalities from interacting with this

individual?

D. What further questions might you want to ask or what other information would you

like to learn about this disability/exceptionality?

Possible Interview Questions: You may pick and choose questions from this list or

make up your own questions. Not every question will apply to every situation.

Tell me about your exceptionality/disability.

When did you first find out that you had this disability? How did you find out?

What was your school experience like? How did teachers/students assist you in school?

Did you have difficulties/frustrations in school? What were those?

Do you recall a particular teacher/person who helped you in school/life?

What kind of support/assistance have you received from your family?

What do you do now? (Work, school, etc.) Do you need any special accommodations to

do your job/school?

What interests do you have outside of school/work? What do you like to do?

What have you learned from having your disability/exceptionality?

What would you want to tell other people about your disability/exceptionality?

What role has your faith played with your disability?