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Family Survey Form
You know your child best. Thank you so much for taking the time to provide me with this information. I look forward to working with you this year!
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Student Name
Your answer
Parent/Guardian name
Your answer
Relationship to student
Your answer
In case I need to call during school hours, please provide the best contact number and the name to go along with that phone number
Your answer
Best email address
Your answer
Best address to send notes/surprises/etc
(Leave blank if uninterested)
Your answer
What are your student’s strengths? Be specific and don’t be bashful. Include as many as you can think of—academic, social, athletic, artistic, musical, etc.
Your answer
What can you tell me about how your student learns best? What kinds of classroom learning environments have helped him/her to learn in the past?
Your answer
What can you tell me about things that get in the way of your student’s learning? What kinds of classroom learning environments have made it more difficult for him/her to learn?
Your answer
Is there anything else you want me to know about your student? This might include but is not limited to current medications, medical or emotional conditions, situations at home, past experiences, etc.
Your answer
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