Family Questionnaire

Please describe your child. What are her/his

greatest strengths, challenges, and needs?

_________________________________________________

________________________________________________

______________________________________
 What are your childs major interests and choices during free
time at home?
__________________________________________________________________

______________________________________________________________
What is your childs favorite book?
_____________________________________________________________
What responsibilities does your child have at home? What are
your expectations of her/him? What are the consequences when
your expectations are not met?
_________________________________________________________________
Are there aspects of your childs life or environment that would be useful for
us to know about? (i.e. single parenting, shared parenting, recent/upcoming
changes at home, etc?)
_______________________________________________________________________

_______________________________________________________________________

Does your child have any special learning or counseling needs? Has she/he
received any professional help relating to these needs?
_______________________________________________________________________

______________________________________________________________________