SCHS Education Questionnaire

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Child's Name:* This field is required.
First Name
Last Name
2
Name of Parent/Guardian completing the questionnaire:* This field is required.
First Name
Last Name
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Email Address for Parent/Guardian completing the questionnaire:* This field is required.
example@example.com
4
1. Are there any physical needs or accommodations we should be aware of for your child (e.g., frequent migraines, vision problems, etc.)?* This field is required.
YESNO
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Please provide a brief description.* This field is required.
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2. Has your child received any academic or behavioral support in the past?* This field is required.
YESNO
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Please provide more details on the type of support your child received (e.g., working in a guided study hall, regular sessions with the school counselor, assistance with test preparation, etc.).* This field is required.
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3. As we explore the academic support that may benefit your child, could you please share if they have any formal plans, such as a 504, an IEP, or a specific diagnosis?* This field is required.
YESNO
9
Please provide a brief description and provide a copy of those documents to the Admissions Coordinator.* This field is required.
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4. Is English the primary language spoken in your home?* This field is required.
YESNO
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Which language is spoken?* This field is required.
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5. Is there any information about your child's behavior or discipline issues at their current school that you think would be helpful for us to know?* This field is required.
YESNO
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Please provide a brief description.* This field is required.
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6. Are there any concerns about your child's past attendance that you'd like to share with us?* This field is required.
YESNO
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Please provide a brief description of the concerns.* This field is required.
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7. Do you have any circumstances that cause you to miss school?* This field is required.
YESNO
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Please provide a brief description of the circumstances.* This field is required.
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8. Have there been any instances of anxiety, depression, or other mental health concerns that have affected your child's learning?* This field is required.
YESNO
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Please provide a brief description.* This field is required.
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9. Is your family currently experiencing any transitions, such as divorce, blending of families, custody disputes, recent moves, or other significant changes?* This field is required.
YESNO
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Please provide a brief description of the situation.* This field is required.
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10. Are there any spiritual concerns that you’d like us to be aware of?* This field is required.
YESNO
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Please provide a brief description of the concerns.* This field is required.
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11. Is there anything else, not covered above, that you would like us to know?* This field is required.
YESNO
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Please provide a brief description.* This field is required.
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