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Student First Name
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Your answer
Student Last Name
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Your answer
Parent/Guardian Name
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Your answer
Parent/Guardian Phone Number (best phone number to reach you)
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Your answer
Who lives at your house? (siblings, pets etc...)
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Your answer
Does your child move between houses?
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No
Yes
Is your child supposed to be wearing glasses?
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Yes
No
Does your child have access to reliable internet?
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Yes
No
What is the most important thing we should know about your child?
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Your answer
What is you child passionate about? Future aspirations?
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Your answer
What does your child do well?
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Your answer
In what area(s) would you like to see improvement for your child?
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Your answer
Overall, how does your child feel about school and 6th grade?
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Your answer
What fears does your child have? (big or small)
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Your answer
What is the best way to motivate your child?
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Your answer
Are there any situations at home that may influence learning (loss of pet, divorce, death of family member or friend, new baby in the family, etc.)?
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Your answer
Anything else you would like to tell me that will help make this a successful year?
Your answer
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