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1S Parent Questionnaire 2019-2020
Welcome to 1S! The information you are filling out below is confidential. Be as candid as you can as it will enable us to support your child most effectively. We look forward to working together this year. Thank you!
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Child's Name: *
Nickname?
Child's Date of Birth: *
MM
/
DD
/
YYYY
Parent 1 Name: *
Cell Phone Number: *
Email: *
Occupation: *
Parent 2 Name (Optional):
Cell Phone Number:
Email:
Occupation:
Siblings (Names, Ages, and School):
Who would you prefer us to call when we need to speak? (Please provide the best number to call) *
Paint a Picture of Your Child. What are 5 words that come to mind when describing your child? *
Interests (3 or more): *
Likes: *
Dislikes: *
Strengths: *
Challenges: *
How does your child deal with frustration? What helps when your child gets frustrated? *
Social:  leader/follower? *
Previous school experience: What school?  What was your child’s experience? *
Any close friendships in 1S or 1L at FL? *
Attitude toward school: reading, math and the arts: *
Developmental milestones: any delays in speech, walking, etc? *
Is your child currently receiving any services? (Speech, OT, PT, etc.) *
Has your child received any services in the past? (If so, please specify age and duration.) *
Are there any physical limitations we should be aware of? *
Are there any significant health or family circumstances we should know about (births, deaths, hospitalizations, travel)? *
Your goals and concerns for your child this year: *
Is there anything else you think we should know in order to better support your child (socially, emotionally, academically)? *
Once again, WELCOME to 1S! We look forward to a wonderful year with your child and your family!
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