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3. Developmental Survey - one per child
In order to keep your children safe and individualize instruction, we need to be aware of any and all developmental issues that may affect your child. This information will aid the Annual Education Plan.
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Student First and Last Name
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Your answer
What subjects do your child excel in?
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Your answer
What subjects are difficult?
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Your answer
Do you feel your child should be in a higher or lower grade than currently enrolled?
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Yes
No
N/A
Has your child been evaluated for any academic, neurological, behavioral, or developmental issues, including Giftedness, ADHD, ASD, SPD, LD, or medically fragile? If so, please describe.
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Your answer
Do you suspect any undiagnosed academic, neurological, behavioral, or developmental issues?
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Your answer
Has your child ever been referred for special education services? If so, is there an IEP on record with the district? (This helps Regina Mater to obtain resources for your child.)
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Your answer
Is your child currently taking medication for a psychological or neurological diagnosis?
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Your answer
Has your child ever been under the care of a professional counselor, psychologist or psychiatrist?
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Your answer
Are you willing to share all previous and future special education information with Regina Mater, and sign a release to share records with Regina Mater?
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Your answer
SPARK - Safety, Preparedness, Attentiveness, Respect, Kindness
"SPARK" expresses the character traits that students must possess in order to thrive in the classroom environment at Regina Mater. Please rate your child on a scale of 1-5 in these areas.
SAFETY
Please answer at your child's ability level no matter what age.
Stays within school campus and classroom boundaries; doesn't wander.
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Not capable at all
1
2
3
4
5
Extremely capable
Able to follow safety directions.
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Not capable at all
1
2
3
4
5
Extremely capable
PREPAREDNESS
Remembers to bring required materials to school: e.g., book bag, lunchbox, etc.
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Not capable at all
1
2
3
4
5
Extremely capable
Able to complete assigned work at home.
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Not capable at all
1
2
3
4
5
Extremely capable
ATTENTIVENESS
Able to listen and follow teacher's directions.
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Not capable at all
1
2
3
4
5
Extremely capable
Able to listen quietly while other students talk.
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Not capable at all
1
2
3
4
5
Extremely capable
Able to work independently in a classroom.
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Not capable at all
1
2
3
4
5
Extremely capable
Able to sit at a desk for age-appropriate amount of time.
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Not capable at all
1
2
3
4
5
Extremely capable
Able to concentrate deeply on a topic of interest.
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Not capable at all
1
2
3
4
5
Extremely capable
Able to follow a group discussion and add relevant insights.
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Not capable at all
1
2
3
4
5
Extremely capable
RESPECT
Recognizes and speaks politely to adults.
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Not capable at all
1
2
3
4
5
Extremely capable
Respects the property of others.
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Not capable at all
1
2
3
4
5
Extremely capable
Respects sacred areas like a sanctuary, chapel.
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Not capable at all
1
2
3
4
5
Extremely capable
KINDNESS
Speaks kindly to peers; affirms others with words.
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Not capable at all
1
2
3
4
5
Extremely capable
Treats younger children with patience and kindness.
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Not capable at all
1
2
3
4
5
Extremely capable
Able to empathize with others.
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Not capable at all
1
2
3
4
5
Extremely capable
Respects personal boundaries: does not hit, kick, etc.
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Not capable at all
1
2
3
4
5
Extremely capable
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