Parent Questionnaire – Grade 3 Parent Questionnaire – Grade 3 Parent Questionnaire – Grade 3 Step 1 of 5 20% Child Name* First Middle Last Suffix Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Current Age*Applying for GradePK3PK4Kindergarten1st Grade2nd Grade3rd Grade4th Grade5th GradePerson(s) Completing the Questionnaire* Email* Thank you for completing this questionnaire about your child. As part of the enrollment process, this will help us to get to know your child. We know that children develop in individual ways so please help us to know what your child is able to do now so that we can predict how they will adjust to being in school. (Please note that we will be using “they” and “their” as a singular or plural pronoun.) I. Play and Social DevelopmentTell us about your child's relationships with you and other family members.*Give some examples of the kinds of things that your child can do independently.Tell us about your child getting dressed in the morning.What can they do by themself?*What do they need help with?*Which of the daily tasks can your child do independently, without any adult help?*Mark all that apply. Going to the bathroom Eating Picking up toys Putting on coat Putting on shoes Opening snack containers Please provide further explanation for items you did not markTell us about your child when they are playing.What does your child like to play?*Give an example of what your child might talk about when they are playing.*How does your child play when with other children their age?* II. Language DevelopmentPlease write the examples in the language that your child is speaking at home. If the language is other than English or Spanish, please provide a translation. A. Give us 3 examples of directions that you gave your child today and that they were able to understand and follow the request.SpanishEnglishB. List 20 words that your child used today.SpanishEnglishC. Give us 3 examples that your child said today.SpanishEnglish III. Fine Motor Skills Before answering these questions, you might want to do one of the following: Give your child a pair of scissors, paper and magazines. Ask: “Cut out pictures that you like to make a collage of your favorite things.” Give your child some small legos or beads/string. Ask: “What can you make with these? Show me how you can make it by yourself.” Please choose as many of these fine motor skills as you would like by circling one descriptor. (Choose at least 1) Cuts along a straight line* Has not started yet Still developing Well developed Cuts along a curved line* Has not started yet Still developing Well developed Manipulates small items like legos or beads with ease* Has not started yet Still developing Well developed IV. LiteracyLanguage Literacy English Spanish Other Please specify language Before answering these questions, you might want to do one of the following: Ask: “Let me hear you sing the alphabet song in English.” “Let me hear you sing the alphabet song in Spanish.” Gather a stack of your child’s favorite books. Ask: “Which book would you like to read to me?” (Let your child read a book to you.) After your child reads a book to you. Ask: “Tell me what happened in the story.” -or- “What did you learn from this book?” Please choose as many of these literacy skills as you would like by circling one descriptor. (Choose at least 2)English: Can recite the ABC with accuracy from A to Z* Has not started yet Still developing Well developed Spanish: Can recite the ABC with accuracy from A to Z* Has not started yet Still developing Well developed English: Use strategies to figure out tricky words like looking at initial sounds or what would sound right in the sentence* Has not started yet Still developing Well developed Spanish: Use strategies to figure out tricky words like looking at initial sounds or what would sound right in the sentence* Has not started yet Still developing Well developed English: Retell some events or information from a familiar story, using specific details from reading* Has not started yet Still developing Well developed Spanish: Retell some events or information from a familiar story, using specific details from reading* Has not started yet Still developing Well developed V. MathematicsBefore answering these questions, you might want to do one of the following: Write several math problems on a piece of paper with 3-digit addition and subtraction (For example: 635 + 927 = 746 – 315 = ) Ask: “Read each problem to me and work it out.” Then ask: “Tell me how you figured it out.” Then ask: “Can you write a story problem that would show how these problems would be used in real life?” Write 3-digit and 4-digit numerals on cards. (For example: 659, 290, 1207, 4801) Ask: “What is the name of this number?” Please choose as many of these mathematics skills as you would like by circling one descriptor. (Choose at least 2)Can add and subtract 3-digit numbers and explain how they got the answer* Has not started yet Still developing Well developed Can read 3-digit and 4-digit numbers* Has not started yet Still developing Well developed Can generate a story problem when given a 3-digit addition or subtraction problem* Has not started yet Still developing Well developed VI. Additional Information about your childHas your child's pediatrician or teacher spoken to you about any developmental difficulties?*Has your child's pediatrician or teacher ever spoken to you about any concerns related to your child's emotional or behavioral development?*Has your child been diagnosed with any of the following? Autism or Autism Spectrum Disorder Development Disability Speech articulation or Language delay Cognitive Disability Physical Disability Behavioral or Emotional Disability ADHD or ADD Sensory Processing Disorder Vision Disability Hearing Disability Learning Disability Has your child's pediatrician, specialist or teacher ever suggested that your child be evaluated for any of the disabilities listed above?* Yes No Please explainIs there anything else that you would like to tell us about your child? Δ
