Thank you for taking the time to complete these questions, so that | know better how to work with you and your child! 1. Student's name: 2. People living in the home with the student and their relationship to the student: 3. Special custody arrangement that | would need to know of 4. Allergies of student, reaction, and medication or treatment needed if it occurs 5. How do you think your child feels about schools 6. What academic goals do you have for your child for the 5" grade year: 7. What are your child's academic strengths: ‘8, What are your child's academic weaknesses or areas of concern: 9. What social goals do you have for your child for the S® grade year: 10. Is there something specific that you need from me to ensure the best educational experience for your child: 11. Are you interested in coming into the classroom to volunteer, if yes, In what capacity 12. What are some things that you would like to see improve in your child's work habits: 13, Does your child read daily during the school year: 14. Did your child read over the summer: 415. Have you had any issues or struggles in terms of getting your child to complete their homework: 116, What motivates your child (such material items and non material): 117. Have you been involved in a SRT meeting for your child? What was the outcome?