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4th Grade Entry Survey 2017-2018
Please answer the following questions. Your input is invaluable in helping me develop a program that fits your child!
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* Indicates required question
Your 4th Grader's First and Last Name
*
Your answer
Parent's names
*
Your answer
Names and ages of others living in household:
*
Your answer
Special interests, fears, strengths, needs:
*
Your answer
General observations about your child's attitude towards school:
*
Your answer
Does your child enjoy being read to?
*
yes
no
How many days a week does someone in your household read books to your child that are above his/her independent reading level?
*
0
1-2
3-4
5-6
every day
What kind/genre of books does your child enjoy reading?
*
Your answer
My child's favorite subject(s) is (are):
*
Math
Reading
Social Studies
Science
Language Arts
Does not have a favorite
Other:
Required
Does your child enjoy reading for enjoyment?
*
yes
no
My child
Is very good with technology
Is ok with technology
Is not interested in technology
Clear selection
What else would you like me to know about your child?
*
Your answer
3 goals you would like to see your child achieve this year:
*
Your answer
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