3rd Grade - Parent Questionnaire | San Jacinto Valley Academy

Please complete the form below. Required fields marked *

Dear Parent/Guardian,

Please print and complete the following questionnaire and submit the form by 8/8/2017. The following information will be used to plan instruction and will remain confidential. Feel free to share as much information as you see fit. If you would like to share additional information, please use the other section at the bottom of the form. Thank you for your time and effort in completing this questionnaire. I look forward to getting to know each student and family and having a productive year.

Contact Information

Student's Name*

Answer Required

Student’s Date of Birth*

Answer Required

Parent/Guardian 1*

Answer Required

Relationship to Student*

Answer Required

Address*

Answer Required

Work Phone*

Answer Required

Mobile Phone*

Answer Required

Email*

Answer Required

Parent/Guardian 2*

Answer Required

Relationship to Student*

Answer Required

Address*

Answer Required

Work Phone*

Answer Required

Cell Phone:*

Answer Required

Email*

Answer Required

Family Information

The student lives with the following adults: (check all that apply)*

Answer Required

Mother(s)

Father(s)

Grandmother

Grandfather

Step-mother

Step-father

Other:

Language(s) spoken at home*

Answer Required

Does the student have internet at home?*

Answer Required

Yes

Siblings at SJVA

Name

Answer Required

Grade

Answer Required

Name

Answer Required

Grade

Answer Required

Is your child*

Answer Required

Car Rider

Walker

Medical Information

Does your child have any allergies or other medical issues? If yes, please explain and note any medications taken at home or at school.

Answer Required

Please note any other conditions that I should be aware of (i.e. seat requirements, bathroom needs).

Answer Required

Other Information

Please list 3 words to describe your child:

Answer Required

What are your child’s strengths?

Answer Required

What does your child struggle with?

Answer Required

Please list 3 goals that you have for your child this year

Answer Required

What does your child enjoy doing? What motivates your child?

Answer Required

Please list any other information that you will feel will make me a better teacher for your child:

Answer Required

Other Information

Answer Required

Please fix the highlighted areas below before submitting.

3rd Grade - Parent Questionnaire

Main Campus

Kinder Site

SJVA District Office