Family Questionnaire for Application
Applicant’s name:
*
Your answer
List any organizations(religious, social, arts, sport-based, etc) that your child and family associate with. *
Your answer
With whom does your child prefer to play (e.g.girls, boys, alone, younger children, adults, siblings)? *
Your answer
Would you say your child is a leader or a follower? *
Your answer
What activities does your child enjoy outdoors? *
Your answer
What activities does your child enjoy indoors? *
Your answer
What books does your child enjoy? *
Your answer
What television programs does your child enjoy? *
Your answer
How does your family spend time together most frequently? *
Your answer
Please list three adjectives that describe your child? *
Your answer
What are your family’s feelings about technology? *
Your answer
What else would you like use to know about your child? *
Your answer
Development
What would you say are your child’s strengths? *
Your answer
Does your child have any health problems of which the school should be aware? If so, please describe. *
Your answer
What food allergies, if any, does your child have? *
Your answer
List any specialists (early intervention, speech, OT, PT, counseling, etc) that your child has seen and describe the reasons for the visit(s). *
Your answer
How does your child handle new or strange situations? *
Your answer
Does your child have any fears (bees, spiders, the dark, etc.)? *
Your answer
Every child has challenges. What kind of challenges do you have most often with your child? *
Your answer
For what is your child most often disciplined? *
Your answer
How do you discipline your child? *
Your answer
Describe your child’s interests, hobbies, and special talents. *
Your answer
On a typical day, would you judge your child to be: *
Has your child ever received services for academic, behavioral, development, or other issues? If yes, please describe. *
Your answer
For students entering 2nd through 8th grades, are there any academic areas that you feel are or may be challenging for your child? *
Your answer
Family Involvement
How do you see yourself becoming involved at NPES? *
Your answer
How do you see yourself supporting your child’s school experience and education? *
Your answer
What in your mind is the ideal parent/ school relationship? *
Your answer
What is your preferred method of communication with the school? *
What other adults play a supportive role in your child’s life? *
Your answer
Information Release
I authorize the release of information regarding my child to North Park Elementary School, 2017 W. Montrose Ave., Chicago, IL 60618.
Child's name *
Your answer
Child's Current School *
Your answer
School Address *
Your answer
School phone number *
Your answer
Child's teacher *
Your answer
Electronic Signature & Date *
Your answer
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