Introducing….Your CHILD!

Welcome to a new school year! As we spend time creating a

classroom learning community, I’d like to know more about your
child through your eyes. The more I know, the better I can tailor an
educational and motivational program to fit his/her particular
needs. Please complete the areas below and have your child return
it to me as soon as possible. Thank you!

Child’s Name: _________________________________________

Parent(s)/Guardian(s): ___________________________________
Address: ______________________________________________
Home Phone Number: ___________________________________
Mom’s Work Number: ___________________________________
Dad’s Work Number: ____________________________________

Any allergies or medical concerns: _________________________

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List five words that best describe your child’s character (e.g.
competitive, cheerful, etc.) ________________________________
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What motivates your child? _______________________________

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What upsets your child? __________________________________

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Which learning skills does your child need to develop? (e.g.
organization, timelines, conflict resolution, etc.)
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Which academic subject(s) is your child’s best? _______________

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Which academic subject(s) does your child struggle with?

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Has your child ever been on a growth plan? __________________

Has your child ever received formal testing that resulted in an

identification and IEP? ___________________________________

What would you say are your child’s strengths?

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Are there any other things you would like me to know about your
child? ________________________________________________
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What are your goals for your child this year?

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As your child’s teacher, what do you hope to see from me?

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