Additional Student Information
CROSS Education
Student Information
Student's Name
*
First Name
Middle Name
Last Name
Other Student Information
Personality
A. Please list three words that would best describe your child’s personality:
B. Please tell us your child’s interests. How does he/she spend free time? What does he/she like to play with?
C. Does your child have any fears or anxieties?
D. Does your child have a particular toy/object that is comforting to him/her?
Developmental History
A. Language
a. How old was your child when he/she began to speak? What language was used?
b. In previous schools, how much instructional time each day was conducted in English?
Please Select
Entirely in English
50% English
Less then 50% English
No English Instruction
c. What language(s) is used in the house? Please be specific regarding the language(s) used by each member of the household, including domestic help.
d. Were there concerns about early language development such as delayed start of speech, problems being understood, etc.?
B. Hearing
Were there concerns about early language development such as delayed start of speech, problems being understood, etc.?
Have you ever suspected a hearing problem?
Yes
No
If yes, please explain:
C. Sight
Has your child had any visual problems? Does your child wear glasses a) for reading or b) for distance vision?
Yes
No
If yes, please explain:
D. Motor
Have there been concerns about your child’s motor development such as delayed start of walking, balance or coordination problems, difficulty with holding a pencil, writing or handling small objects?
Yes
No
If yes, please explain:
Social Development
Feeling or Behavior
1. Sticks to one activity (e.g. listens to story) for at least 15 minutes at a time:
Almost Always
Sometimes
Never
2. Accepts own limits without getting upset:
Almost Always
Sometimes
Never
3. Plays well with other children (e.g. takes turns and shares):
Almost Always
Sometimes
Never
4. Stops an activity when told to do so:
Almost Always
Sometimes
Never
5. Does what is asked by a parent:
Almost Always
Sometimes
Never
6. Separates easily from parent/ caregiver:
Almost Always
Sometimes
Never
7. Has temper tantrums:
Almost Always
Sometimes
Never
8. Is easily frustrated and cries often:
Almost Always
Sometimes
Never
9. Notices other people's feelings:
Almost Always
Sometimes
Never
10. Waits to hear the whole question before answering:
Almost Always
Sometimes
Never
11. Likes to be with other people:
Almost Always
Sometimes
Never
Health
A. Has your child had any serious illness, significant allergies, surgery or a major accident? If yes, please explain:
B. Is your child regularly taking medication or receiving frequent medical treatment? If yes, please explain:
Family Information
A. Please list the names and relationships of immediate family members as well as other people who live with the child. Please include domestic help and the birthdates of siblings.
B. Is your child affectionate to members of the family?
Almost Always
Sometimes
Never
C. Describe your child’s separation behavior when you leave him/her with other caregivers.
D. Who are the main people responsible for establishing behavioral expectations and consequences for your child (mother, father, domestic help, others)? Please explain.
E. What form of discipline do you use at home and how does your child respond to discipline?
F. Is there anything unique about your family that you’d like to share with us that would be useful in our work with your child?
School History
A. List of previous school/s attended
B. Did the previous school personnel express any areas for attention regarding your child’s academic or behavioral needs? If yes, please explain:
Has your child received any of the following services? Please check:
Rows
In School
Out of School
Name/ Phone No. / Email
Language/ Speech Therapist
Physical/ Occupational Therapist
Psychologist/ Psychiatrist/ Counselor
Resource (for special learning needs)
Tutor
ESL (English-as-a-second-language)
Please attach a copy of any important reports from these specialist
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Summary
A. Is there any other information you would like to share relevant to your child?
B. What do you expect your child to accomplish this year?
Upload Requirements
*If not submitted yet.
Requirements Details:
BIRTH CERTIFICATE
: Original copy issued by the Philippine Statistics Authority
PROOF OF GRADE LEVEL
: Original copy of the most recent report card (Form 138) duly signed by the school head. The report card should clearly indicate the grade level completed and certify eligibility for admission or Transfer
TRANSCRIPTS/RECORDS
:
- From Philippine-based schools: SF10 / Form 137 from last school attended
- From schools outside the Philippines: Original school records
LRN
(Learning Reference Number) For incoming Kinder and Grade 1-6 student from Philippine schools
ID picture
: Digital copy of the child’s updated photo (taken within 6 months)
File Upload
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SUBMIT
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