Parent - Child Find Request and Developmental History
The information collected on this form will be used by your child's school to help them determine your child's educational needs. It is not required for you to complete this form. If there are any questions you do not wish to answer or you feel uncomfortable answering, feel free to leave them blank.
Student's School
Student's Home Room Teacher
Person Making the Request
First Name
Last Name
Requester's Email Address
example@example.com
Requester's Phone Number
-
Area Code
Phone Number
Relation to the Child
Parent
Guardian
Family Member
Teacher
CPS Worker
Foster Parent
Other
Student's Name
First Name
Middle Name
Last Name
Birth Date
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
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Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
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1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Gender
Please Select
Male
Female
N/A
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Is any language other than English spoken in the student's home?
Yes
No
Parent/Guardian's Language
Child's Language
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Student Information
Describe the student's strengths.
Please describe, in detail, any concerns that you have for your child.
Please describe any situational circumstances relevant to the student (recent divorce, custody disputes, financial hardship, trauma,
How many School Districts has the student been enrolled in over the past 3 years.
1
2
3
4
5
6
7
8
Over the past 3 years, has the student frequently been absent from school?
yes
no
What was the reason for the student's absence from school?
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Developmental History / Health
Were there any problems with the child's birth or during early childhood?
yes
no
Describe any problems in birth or early childhood that may have impacted your child's development.
Has your child had any operations?
yes
no
List the operation and the student's age at the time of the operation.
Has your child had any significant accident/injuries?
yes
no
List the injuries and the student's age at the time of the injury.
Has the student ever received speech, occupational, or physical therapy?
yes
no
List the therapy and the student's age while receiving therapy.
Does the student have a medical or mental health diagnosis for an ongoing condition?
Yes
No
List each diagnosis and the medical / mental health provider who treats the student.
Does the student take medication on a regular basis?
Yes
No
List each medication and dosage.
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Educational / Cognitive
Does your child regularly need any of the following? Check all that apply.
significant help with homework
afterschool tutoring
significant help organizing their school work
follow-up to ensure s/he completes homework
instructions or directions to be repeated or explained
Other
Indicate any areas that your child has difficulties with:
Getting along with teachers
Basic math calculations
Reading aloud, pronouncing words
Planning ahead/solving problems
figuring money,time,etc
Understanding what s/he reads
Other
Describe any difficulties the student has with thinking or learning activities
Has the student ever been evaluated/assessed/tested for learning difficulties?
yes
no
Who evaluated the child, and what were the results of the assessment?
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Adaptive
Choose the items that the student can do independently
Groom his/herself
Complete household chores
Run errands for the family
Take care of his/her possessions
Take care of younger siblings
Handle money/ make change
Other
Describe any difficulties the student has with daily living skills.
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Communication
Do you have any concerns about the following. Choose all that apply.
Articulation (pronouncing sentences and words)
Receptive language (Understanding what others say)
Expressive language (Expressing thoughts and feelings)
Other
Describe any concerns about the student's speech/language skills
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Social / Emotional / Behavioral
Indicate if the student has any of the following difficulties
Difficulty making friends
Aggression/fighting
Withdrawn or keeps to self
Being a victim of teasing/bullying
Anxious in groups of people
Inflexible/difficulty compromising
Engaging in teasing/bullying behavior
Fearful of speaking in social settings
Insensitive to others' emotions/needs
Other
Describe any concerns about the student's ability to get along with peers.
Indicate if the child has any of the following difficulties
Extremely fearful or nervoud
Depressed or very unhappy
Self-injurious
Cries easily or whines frequently
Easily frustrated
Suicidal thoughts
Frequently complains of aches/pains
Explosive/angry outbursts
Obsessive/compulsive behaviors
Other
Describe any concerns about the student's emotional functioning
Indicate if the student has had any of the following difficulties:
Stealing or lying
Drug / Alcohol Abuse
Gang involvement
Cruelty to animals
Defiance/oppositional behavior
Destructive behaviors/starts fires
Skipping school repeatedly
Suspensions
Expulsions
Describe any concerns you have about the student's behavior
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What is the best time of day to contact you?
What is the best day to arrange a meeting with you?
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