Room 9 - Back to School Survey
To start off the year, I like to ask parents to fill out a form regarding any information you feel is pertinent for me to know about your child, as well as about your learning situation at home. I encourage you and your child to fill out this form together! This will help me get to know your child and your family.
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Email *
Your child's first name: *
Your child's last name: *
Your child's birthday *
Parent/Guardian #1 First and Last Name and Relationship to Child: *
Parent/Guardian #1 Email (if none, please put n/a): *
Parent/Guardian #1 Home Phone Number: *
Parent/Guardian #1 Cell Phone Number:
Parent/Guardian #1 preferred form of contact: *
Parent/Guardian #2  Full Name and Relationship to Child: *
Parent/Guardian #2 Email (if none, please put n/a): *
Parent/Guardian #2 Home Phone Number: *
Parent #2 Cell Phone Number:
Parent/Guardian #2 preferred form of contact: *
What languages are spoken at home? *
Any siblings at home? *
Required
If "yes" there are siblings at home, please list their age or grade level and what school they attend.  Please list teacher name of siblings who attend MSJE. If "no" please put n/a: *
What device will your child be using for distance learning?  Please check all that apply. *
Required
How would you rate your child's comfortability with digital learning (completing assignments with online platforms such as Google Classroom, Benchmark, etc.) *
not comfortable at all
very comfortable
How would you rate your typing skills? *
Beginning
Able to type quickly with little or no frustration
Does your child have access to a stable internet connection at home? *
What was your child's typical schoolwork routine last spring during shelter-in-place learning (time it is done, independently, with help, etc.)? How did you support them with classwork and projects?
What would you say WENT WELL for your child and family during distance learning in the spring of 2020? Please give details or examples if possible.
What would you say DID NOT go well for your child and family during distance learning in the spring of 2020? Please give details or examples if possible. *
How would you describe your child's personality traits?
What other after school/weekend activity is your child involved in? Hobbies and extracurricular interests?
My child and I are excited about ______ this year: *
My child and I are nervous/concerned about:
Please share any other information you would like me to know as we begin this school year:
Are you comfortable with me sharing a class contact page with parent emails/phone numbers? I am encouraging families to allow the students to zoom together after school hours to socialize and/or do homework together. *
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