Kindergarten Family Survey, 2022
We are so excited for your little one to start with us in Kindergarten next fall!

This survey will be used for informational purposes by school personnel only, including your child's principal, counselor, and teacher. Your feedback will be very helpful for us, as we create classes for our Kindergartners! Anything you provide here is confidential. The questions reflect some of the things we'll be working on throughout the course of the school year. Our goal is to meet your child where he/she is and this feedback is the beginning of helping ensure we can do that!
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Last name of person completing this form *
First name of person completing this form *
Child's last name *
Child's first name *
Child's preferred nickname?
Your relationship to the child: *
Did your child attend preschool during the current school year? *
If your child attended preschool during the current school year, which one was it?
Is your child receiving services from an outside agency (Speech, Language, Occupational Therapy and/or Physical Therapy, etc.)? *
If your child is receiving any specialized services, what are they and how frequently? *
What are two or three of your child's personal strengths? *
What are two or three areas in which your child needs to grow? *
Does your child exhibit any challenging behaviors? *
If you think your child exhibits challenging behaviors, what are they?
Are there any behavior techniques you've found helpful with your child that you'd like to share with us?
Have there been any recent life events that have occurred in your family that could impact your child's transition to Kindergarten? *
Please describe how your child is feeling about starting Kindergarten this coming year? *
Communication Skills. Your child ...
Follows two-step directions, for example, "Please go and put your shoes away then come have your snack." *
Not often
Regulalry
Regularly engages in conversation with peers *
Not often
Yes
Regularly expresses their needs or feelings appropriately *
Not yet
Yes
Deciphers the emotions of others, for example, sadness, frustration, joy, etc. *
Not yet
Yes
Sits and listens to a short story from beginning to end *
Not yet
Yes
Interpersonal Skills. Your child ...
Responds to and makes verbal greetings at appropriate times (e.g., good morning, hello, bye-bye, etc.) *
Not really
Regularly
Shows interest in playing with peers *
Not really
Regularly
Cooperates with peers during play time *
Not really
Regularly
Separates from parents/guardians when needed, e.g., for school, to run errands, etc. *
Not really
Yes
Negotiates with peers to resolve conflicts without resorting to physical contact *
Not really
Regularly
Uses kind word toward others *
Not often
Regularly
Exhibits impulse control and self-regulation, e.g., uses appropriate words to express anger when something is taken away or shows patience when waiting for a turn, etc. *
Not often
Regularly
Follows rules when participating in activities/games *
Not often
Regularly
Emerging independence. Your child ...
Can say first and last name when asked *
Not yet
Yes
Knows his/her home address and best mobile/home phone number *
Not yet
Yes
Knows his/her birthdate and will share when asked *
Not yet
Yes
Goes to the bathroom by himself/herself and wipes, washes hands *
Not yet
Yes
Emerging math skills. You child ...
Can recite numbers 1 through 10 *
Not yet
Yes
Correctly uses words like, "smaller" and "bigger" or "lighter" and "heavier" *
Not yet
Yes
Describes how items are similar or different *
Not yet
Yes
Can identify common shapes: squares, circles, rectangles, etc. *
Not yet
Yes
Can identify at least five different colors, e.g. red, blue, green, etc. *
Not yet
Yes
Emerging Literacy Skills. your child ...
Can identify the letters of the alphabet *
Not yet
Yes
Knows the difference between upper and lower case letters *
Not yet
Yes
Understands that letters make up words *
Not Yet
Yes
Can identify common words out in the environment, e.g., the word, "Stop" on a stop sign *
Not yet
Yes
Makes correct sounds to correspond with letters *
Not yet
Yes
Can recognize rhyming words *
Not often
Regularly
Can write their name independently *
Not yet
Yes
Large and small motor skills. Your child ...
Can jump forward with both feet together *
Not yet
Yes
Can kick a kickball *
Not yet
Yes
Can catch a ball with their hands *
Not yet
Yes
Gets dressed independently *
Not yet
Yes
Can trace simple shapes *
Not yet
Yes
Is there anything else you would like to share with us about your incoming Kindergartener?
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