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Parent Survey
Please fill out the following information to help me get to know you and better teach your child.
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* Indicates required question
Student Name (Please indicate if they prefer to be called a different name in class.)
*
Your answer
1st Parent/Guardian Name
*
Your answer
Cell Phone Number
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Your answer
Work Phone Number
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Your answer
2nd Parent/Guardian Name
*
Your answer
Cell Phone Number
*
Your answer
Work Phone Number
*
Your answer
Emergency Contact: Name & Relationship
*
Your answer
Phone Number
*
Your answer
Email you prefer I use:
*
Option 1
What are three words you would use to describe your child?
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Your answer
What are you child's favorite and least favorite school activities?
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Your answer
How does your child feel about school?
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Your answer
What goals do you have for your child this year? (Social/Academic)
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Your answer
What areas are you most concerned about? (Select all that apply)
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Work habits at school
Work habits at home
Attentive listening
Self-Esteem
Respect for others
Peer Relationships
Self-control
Bullying
Required
How did you child do with online learning this past year?
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Your answer
Please list any other concerns you have for your child or elaborate on any from above.
Your answer
Please list anything else you would like me to know about your child.
Your answer
Do you have internet access to complete homework?
*
Yes
No
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