Parent Input Form

Thank you for taking the time to complete this parent input form. You know your child best and can offer helpful insights from a unique perspective, your participation is greatly
valued as a member of the team. Though filling out all or any part of this form is optional, your ideas and opinions will help the team better understand your child and guide us in
developing an appropriate individualized educational program.

1. Email

2. Student Name
First and Last

3. Your name

4. Relation to the student

Mark only one oval.

Mother

Father

Other:

5. Date

Example: January 7, 2019

6. Student Strengths
Describe your student's social and educational strengths.

7. Behavior
Describe behavior at home or school that interferes with academic performance. Leave blank if there is no behavior you are concerned with.
8. Parent Concerns
List any concerns you have for your child regarding their education, behavior, social interactions, progress, well being, etc.

9. Student Concerns
List any concerns your student has expressed about school.

10. Successful Strategies & Supports

Share any strategies or supports that have been successful for your student at home, at school or both.

11. Questions
Do you have any questions about this upcoming IEP meeting? Please be sure to submit this at least 2 days prior to the IEP meeting to allow time to prepare answers to any questions.

12. Additional Comments

Leave any additional comments. Leave blank if none.

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