Elementary Parent Questionnaire

Student's First Name:*

Student's Last Name:*

Likes to be called:

Student's Date of Birth:

Class Applying For :* Lower Elementary Upper Elementary

Lower Elementary (Grades 1-3) Upper Elementary (Grades 4-6)

Student's Gender

Does your child have any suspected special needs?

Has your child been hospitalized? Duration? Reason?

Is your child on any routine medications? If yes, please state why:

Does your child have any Allergies / Medical Conditions?

Name of Allergy and/or Medical Conditions:

Treatment of Allergies or Medical Condition:

Please share with us any medical history, or diagnostic evaluations (educational, physical or psychological) that pertain to your child:

Current Grade:*

1. What personality traits and qualities in your child do you most enjoy?*

2. Please comment on your child's interaction with peers and adults.*

3. How does your child respond to academic challenge?*

4. Please comment on your child's work behavior (personal initiative, self discipline, school work, organization).*

5. Does your child have any difficulties or challenges in the classroom (either academic or otherwise) that we should be aware of?*

If yes, please explain:

6. Has your child had any remedial work, special tutoring or enrichment classes?*

7. What academic area(s) is your child particularly interested in that may help us guide their education most effectively?*

What responsibilities, if any, does your child have at home?

Additional comments