Home Data Survey 2025-2026
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Student Name *
Your child's homeroom teacher *
If you do not see your child's name, please type it below.  
Last Name, First Name - Example: Smith,  John
Parent/Guardian Name *
Last Name,  First Name—Example Smith,  John
2nd Parent/Guardian Name
Last Name,  First Name—Example Smith,  John
Parent/Guardian Email Address 1 *
Parent/Guardian Email Address 2
Please put another email address here if you would like to receive emails in another account.
Alternate Email Address
Please put another email address here if you would like to receive emails in another account.
Cell Phone 1
Please use this format 773 555 5555
Cell Phone 2
Please use this format 773 555 5555
Work Phone 1
Please use this format 773 555 5555
Work Phone 2
Please use this format 773 555 5555
Home Phone
Please use this format 773 555 5555
Do you have a computer at home? *
Do you have internet service at home? *
Are you interested in chaperoning team field trips? *
What would you like teachers to know about your child?  
Do you have any questions you would like to ask teachers?
Is there anything else you would like to share with teachers?
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This form was created inside of Chicago Public Schools.