Parent/Guardian Questionnaire - 1st Grade
Please read each item below and check the column on the right that best applies to this child.
Child's Name
First Name
Last Name
What is the name of your child's current school?
Describe your child's feelings towards school.
Has your child ever been asked to leave or limit participation in his/her current school or previous schools/daycares?
Yes
No
If yes, what was the reason?
Please share some information about your family: What activities do you enjoy doing together? Who lives in the household? Is there anything you feel is important for us to know about your child?
Names ten colors when requested?
Always
Often
Rarely
Answers “where” and “when” questions?
Always
Often
Rarely
Follows three-step directions in the sequence given?
Always
Often
Rarely
Speaks clearly in complete sentences of at least seven words?
Always
Often
Rarely
Tells others his/her first and last name?
Always
Often
Rarely
Tells others his/her age?
Always
Often
Rarely
Tells others his/her birthday when asked (month and day)?
Always
Often
Rarely
Retells a story with a beginning, middle, and end?
Always
Often
Rarely
Recognizes and names all uppercase letters?
Always
Often
Rarely
Prints some uppercase letters in sequence?
Always
Often
Rarely
Recognizes and names all lowercase letters?
Always
Often
Rarely
Prints some lowercase letters in sequence?
Always
Often
Rarely
Tries to read words by using phonics, context clues, or picture clues?
Always
Often
Rarely
Counts by rote to 30?
Always
Often
Rarely
Recognizes all numerals to 20?
Always
Often
Rarely
Can write numerals in sequence to 10?
Always
Often
Rarely
Can compute addition facts with sums to 6?
Always
Often
Rarely
Can compute subtraction facts with answers to 8?
Always
Often
Rarely
Walks up and down stairs using alternating feet?
Always
Often
Rarely
Uses the same hand as the preferred hand?
Always
Often
Rarely
Follows the pattern of working left to right and top to bottom?
Always
Often
Rarely
Prints his/her first name?
Always
Often
Rarely
Draws pictures that are recognizable?
Always
Often
Rarely
Independently manages personal items (coat, backpack, etc.)?
Always
Often
Rarely
Cares for toileting needs independently?
Always
Often
Rarely
Knows which shoe goes on which foot?
Always
Often
Rarely
Ties his/her shoes?
Always
Often
Rarely
Reacts to disappointment and failure in a reasonable manner?
Always
Often
Rarely
Shares and takes turns willingly?
Always
Often
Rarely
Plays cooperatively in a large-group activity or game?
Always
Often
Rarely
Shares ideas willingly with adults?
Always
Often
Rarely
Shows concern for using materials safely and appropriately?
Always
Often
Rarely
Uses scissors correctly?
Always
Often
Rarely
Able to sit for a 15 minute lesson?
Always
Often
Rarely
Makes an effort to solve problems before seeking help?
Always
Often
Rarely
Follows classroom routines?
Always
Often
Rarely
Continues a task until completed or until it is time to stop?
Always
Often
Rarely
Transitions appropriately from one activity to another?
Always
Often
Rarely
Asks before using another child’s toy or things?
Always
Often
Rarely
Your Name
First Name
Last Name
Email
example@example.com
Best Contact Number
Please enter a valid phone number.
Signature
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