Please take the time to
complete both sides of this
form. I look forward to reading
your responses and getting to
know your child better!
Student’s Name: _____________________
Birthday: ________________ Age: _______
Parents’/Guardians’ Names:
___________________________________
___________________________________
Phone #: ____________________________
E-mail: _____________________________
What are your child’s strengths?
5 Words that
Describe
Your Child
1.
2.
What are your child’s weaknesses?
Do you have a homework routine? Explain.
3.
What motivates your child?
4.
5.
List any school-aged siblings with grade level.
What kinds of things upset your
child?
Three goals for your child this year:
1.
2.
3.
Are there any personal or medical problems I should be aware of? Allergies?
Are there any holidays that your family does NOT
celebrate?
Other comments/concerns you’d like to share:
A few of
your child’s
favorite
things:
1.
2.
3.
4.
5.