Educational History Report
The purpose of this form is to gain an understanding of the educational history of a new student enrolling in Journey Academy.  We ask each parent to think over the past few years of educational experience so that we can best serve each hero that enters our school.  Please complete this form for each newly enrolled learner.
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Who is completing this questionnaire?
Please tell us the student's name, age, and birthday (eg: John Miller - age 13 - 12/2/2009):
Please give a brief description of your student’s last year of educational experience.  What school did they attend?  What enrichment programs were they a part of?  If homeschooled, please give a brief description of your average day and hours spent in instruction.
Has your student ever been evaluated educationally by either a public school (through an IEP) or through a private educational testing company? What was the outcome?
Has your student ever been evaluated by a psychologist and been formally tested or diagnosed with any type of disorder? Please explain.
Does your student have any social-emotional struggles that you feel would be helpful for us to know about or may have an effect on their learning?
Math - What was the last math program your student was working on?  How far did they get through the school year?  
Approximately, at what grade level would you say your student is proficient in regarding math?
Do you believe your student has any special struggles in math that we should be aware of? Do you think they need any special intervention?
Language Arts - What was the last reading or language program your student was working on?  How far did they get through the program?
Approximately, at what grade level do you think your student reads?
Approximately, at what grade level do you think your student writes?
Has your student ever taken a standardized test?  If so, what test was it and can you either send us the results or summarize the results?  (common standardized tests are Iowa Test of Basic Skills, California Achievement Test, and Stanford Achievement Test)
Do you believe your student has any specific struggles in reading or writing?  Do you think they need any special intervention?
Is there anything you feel would be important for us to know about your student's educational history so that we can best serve your family?
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