Early Childhood Special Education Program Questionnaire
Welcome to the ECSE Preschool Program.  Please help us get to know your child better by providing the following information. We will be sending home many papers throughout the school year.  Please check your child’s backpack daily.  We look forward to working together this year!
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Student's First and Last Name *
1.  What are the names of your family members and identify who they are, i.e. Grandmother, etc.
2.  Do you have any pets? What are their names?
3.  Does your child have a nickname?
4.  Does your child have any food allergies or special health concerns you would like us to be aware of?
5.  Does your child require any medication regularly?
6.  Does your child have any fears we should be aware of, i.e. dogs, etc.?
7. Is your child toilet trained?  If not, please let us know what you have done so far and how you would like us to approach toilet training you child.
8. How does your child communicate their needs and wants?
9. What are your concerns regarding your child’s development or speech?
10. What are your child’s favorite foods?
11. Does your child attend daycare or go to a babysitter for part of their day?  If yes, please provide the name and hours.
12. What is your child’s favorite story or book?
13. What does your child like to do, i.e. ride bike, etc.
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