Student Information Survey- to be completed by an adult
Dear Parent/Guardian:  Thank you for taking the time to complete this survey.  Please be sure to complete it as thoroughly as you can because the information that you provide will help me to help your child grow and succeed this year.
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Email *
Student's Full Name *
Nickname (if any)
Name/relationship of person completing survey *
Who is your child's homeroom teacher?  Please check one. *
Please list siblings and ages *
Who does the student live with?  (check all that apply) *
Required
Other household members:
Do you have any pets at home?  Explain. *
Would you like to share any information regarding religious background and/or holidays celebrated (or not celebrated)? *
Is your child supposed to be wearing glasses? *
If your child IS supposed to be wearing glasses, will he or she have them at school?    If not, please explain. *
Describe any medical/physical conditions and food/medicine allergies that your child has: *
What can I do as a teacher to help your child be successful this year? *
Please write a few sentences or paragraphs to tell me more about your child.  Include any of the following, or anything else you feel would help me to get to know your child better:                                                           feelings about reading, math, or other subjects;                                                    study habits,                                                                         your child's social skills and how he/she relates to other children,                                                              situations at home that may influence learning (loss of pet, divorce, death of family member, new baby, etc.); concerns or worries that you may have concerning your child's education. *
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