Kindergarten Student Interview Questionnaire
Please complete this questionnaire to help us get to know your child and support their transition into kindergarten.
Student's Full Name
*
First Name
Last Name
Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian Email Address
example@example.com
How would you describe your child's personality?
Which of the following best describes your child's social interaction?
*
Prefers playing alone
Enjoys small groups
Enjoys large groups
Other
Which activities does your child enjoy?
Drawing or coloring
Building with blocks
Outdoor play
Reading or listening to stories
Music and singing
Puzzles or games
Other
Please rate your child's skills in the following areas:
*
Rows
Not Yet
Emerging
Proficient
Following directions
1
2
3
Expressing needs verbally
4
5
6
Using the restroom independently
7
8
9
Fine motor skills (e.g., holding a pencil)
10
11
12
Gross motor skills (e.g., running, jumping)
13
14
15
How comfortable is your child with separating from parent/guardian?
1
2
3
4
5
Does your child have any allergies or medical conditions?
Is there anything else you would like us to know about your child?
Submit
Should be Empty: