Student Questionnaire

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Date
MM slash DD slash YYYY
Student Name*
First Last
Parent Name*
First Last
Email*
What kinds of self-care activities (dressing, washing, etc.) is your child able to do independently?
Does your child use the bathroom independently? Does your child wear cloth underwear, pull-ups or diapers?
What is your child’s favorite book/s?
Does your family observe religious or cultural traditions you would like to share with us so that we might better support your child?
What helped you choose HSPK for your child?
Does your child have special interests?
What kinds of activities do you do with your child?
What approach to discipline do you use with your child?
Does your child make eye contact when spoken to by you? To others outside the family?
Does your child respond to verbal direction? Does your child answer to his/her name? How do you respond when your child refuses to listen to direction?
Please detail any experiences that you think your child’s teachers need to be aware of such as birth difficulties, adoption, separation, divorce, serious illness, death, hospitalization, moves, therapy, etc. Include medical/physical conditions, including therapies both past and present, such as occupational, physical, psychological, vision, speech, etc.
What are your hopes for your child at HSPK?
What are the qualities you appreciate about your child?
What is your sense of your child’s needs as a learner?
Does your child have any fears, special diet, or anything else specific you would like to share?
Additional Comments
Comments
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