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Date Received
CHALLENGER ELEMENTARY
PLACEMENT CONSIDERATION FORM
Student Name_________________________________________ Date_______________
Present Teacher____________________________________ Grade Next year___________
1. Please describe your childs strengths and/or weaknesses (i.e. work habits, study skills, personality
traits, motivation levels, etc.)
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2. Please describe any special considerations you have concerning your child. Special considerations
may include special family situations, emotional needs, educational needs, etc.
__________________________________________________________________________________________
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3. Please describe the type of learning environment you feel would best meet these needs. For
example, would a highly structured or more moderately structured learning environment be best?
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4. Did a sibling have a relationship with a teacher in this grade level? YES NO
Who?_________________
Comments:_______________________________________________________________________________
__________________________________________________________________________________________
5. Other:
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Thank you for this information on your child. All special considerations will be thoroughly reviewed.
Due to the nature of this process there is NO GUARANTEE of special placement of your child. This
form must be received in the Office no later than March 1st.
Parent/Guardian Signature________________________________________________________________

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