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Parent Questionnaire
Please fill out the following questions.
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* Indicates required question
Name
*
Your answer
Child(ren)'s Name
*
0 points
Your answer
What was your elementary educational experience?
*
very positive
mostly positive
average
mostly negative
very negative
Required
Learning to read for me was
*
very difficult
a little difficult
easy
very easy
I don't remember
Required
What is the highest level of education you completed?
*
High School Diploma
2 or 4 Year College Degree
Masters Degree
Other
Required
Has anyone in your family been diagnosed with dyslexia?
*
Yes
No
Unsure
How does your child learn best?
*
Seeing
Listening
Doing - Hands On
Moving
Singing
Does your child enjoy reading?
*
Yes
No
Unsure
Required
What are your reading goals for your child?
*
Your answer
Does your job, schedule, and family commitments allow for reading time with your child nightly?
*
Most nights
Some nights
Few nights
No
What is one thing you would like me to do with/for your child this school year?
*
Your answer
I will communicate through text (Remind) and e-mail this year. Please list your cell phone number and e-mail address.
*
Your answer
Do you prefer English or Spanish communication?
*
English
Spanish
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