Parent Survey
Student: ______
Parents: ______
Date Completed: ______
The following set of questions has been compiled so that school staff may better understand your child, which will help us provide better instruction and programming. Please make at least one comment in each area and provide as much information as you can or wish!
What does your child do best?
What does your child have most difficulty with?
If left alone, what will your child do?
(How does he or she spend most of his or her time?)
What toys or other objects does your child like?
What are your child’s favorite foods?
Is there time during the day when your child functions best? Is least attentive?
Under what conditions does your child work / play best? (For example: sitting at a table, in a small space, with no distractions, in specific rooms, etc.)
How much assistance does your child require with toileting?
How does your child indicate the need to toilet?
Does your child indicate when he is hungry, thirsty, other needs? How?
What behavior problems interfere with your child working / playing? How frequently do these occur? Under what circumstances?
Are there materials or activities that upset your child or that he is afraid of?
Will your child go into the following public places with appropriate behaviors?
Store? Yes No Comments:
Restaurants? Yes No Comments
Movies? Yes No Comments:
Doctors? Yes No Comments:
How does your child react to going to public places in general?
How are your child’s behavior problems usually managed? (For example: time out, removal of toys, reprimand, ignoring)
What reinforcement (reward) works best with your child?
Please list any words that your child uses spontaneously (say, signs, or gestures without your saying or signing the word first) and appropriately.
Does your child participate in bathing, tooth brushing, hair brushing, etc?
What are the names of parents, siblings, teachers, special friends, and pets that your child uses or relates to?
Is your child on a special diet? If yes, please describe.
Does your child have medical problems that a teacher should be aware of? (Seizures, diabetes, allergies, etc)
Is your child on any medication? When is medication given? By whom?
Additional comments or information:
Thanks for your time!