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Parent Questionnaire
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Email
*
Your email
Child's Name:
Your answer
Date:
MM
/
DD
/
YYYY
Parent's Name:
*
Your answer
Play Habits
What does your child choose to do most often? Describe.
*
Your answer
What does your child appear to dislike?
Your answer
Does your child prefer to play with others/alone? Describe.
*
Your answer
Reading/Writing Experiences
Describe earliest reading experiences and favorite books.
*
Your answer
Does your child like to be read to? How often? How Long?
Your answer
Does your child look at books on his/her own?
*
Your answer
If so, how does your child “look” at books independently?
Your answer
Does your child write yet? If so, what does he/she write? (i.e. letters, name, words, sentences, stories, etc.)
Your answer
Describe earliest writing experiences.
*
Your answer
Does your child have any second language experiences?
*
Your answer
Favorite toys, recordings, or tv shows?
Your answer
Interests? (sports, music, art, dance, gymnastics, etc.)
Your answer
How would you characterize your child as a learner?
*
Your answer
Does he/she prefer to work with others?
Your answer
Does he/she talk while working?
Your answer
Does he/she move actively about as he/she works or listens?
Your answer
Does he/she handle things as he/she investigates them?
Your answer
Does he/she stick to one project for long periods or changes projects frequently?
Your answer
Does he/she prefer to practice new things in private or public?
Your answer
Does your child have a nickname?
Your answer
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