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Parent/Guardian Questionnaire
Please complete this form to help Mrs. Keeley get to know your child and how to best support their individual needs for a successful school year.
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* Indicates required question
Student name (first & last)
*
Your answer
Student's preferred name/nickname
(ex. Matthew = Matt)
Your answer
Name of parent/guardian completing this form
*
Your answer
Relationship to student
*
(mother, father, grandparent, etc.)
Your answer
Parent/guardian primary email
*
Your answer
Describe your child's areas of STRENGTH.
*
(academic & non-academic)
Your answer
Describe your child's areas of NEED.
*
(academic & non-academic)
Your answer
What supports/accommodations do you feel have been the MOST SUCCESSFUL for your child?
*
Your answer
What supports/accommodations, if any, do you feel have been the LEAST SUCCESSFUL for your child?
Your answer
What are your goals for your child this year?
*
Your answer
What is your child's attitude towards school?
*
Your answer
Is your child involved in extracurricular clubs/sports? If so, which ones?
Your answer
Please share any further information that you believe will help me get to know your child and their specific needs better.
*
Your answer
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