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Willis - Intake Conference Form 2023
Please answer all of the questions on this form to help me better get to know your child.
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* Indicates required question
Child's First & Last Name
*
Your answer
How many members are in your family?
Your answer
List student's siblings and their teacher's name
(Ex. Micah/Fogarty; Josiah/High school)
Your answer
Do you read together?
Your answer
How does your child feel about reading?
Your answer
How does your child feel about math?
Your answer
How does your child feel about writing?
Your answer
What are your child's greatest strengths?
Your answer
What are your child's greatest needs?
Your answer
How does your child interact with others?
Your answer
Do you have a quiet place for your child to work and do homework?
yes
no
Clear selection
What, if any, type of help does your child ask for on schoolwork?
Your answer
What is your child's attitude toward school or learning?
Your answer
Does your child like to read for pleasure?
yes
no
somewhat
Clear selection
What are your child's special interests at home?
Your answer
What goals do you have for your child this year?
Your answer
How can we best handle your child in case of a behavior problem?
Your answer
Is there anything else that you would like to share about your child that would help make the school year successful?
i.e. health, family, social concerns
Your answer
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