Child Education Assessment Questionnaire Form
Please complete this form to help us understand your child's education needs and learning context. All responses remain confidential and are used solely for assessment purposes.
Child's First Name
*
First Name
Last Name
Current Grade Level
*
Please Select
Preschool
Kindergarten
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Grade 12
Other
How would you describe your child's overall attitude towards learning?
*
Very Negative
1
2
3
4
Very Positive
5
1 is Very Negative, 5 is Very Positive
Which learning environment does your child prefer?
*
Individual (one-on-one)
Small group
Large classroom
Online/virtual
No preference
Other
Please rate your child's confidence in the following academic areas:
*
Rows
Very Low
Low
Average
High
Very High
Reading
1
2
3
4
5
Writing
6
7
8
9
10
Mathematics
11
12
13
14
15
Science
16
17
18
19
20
Social Studies
21
22
23
24
25
How motivated is your child to complete homework and assignments?
*
Not Motivated
1
2
3
4
Highly Motivated
5
1 is Not Motivated, 5 is Highly Motivated
Which learning style best describes your child?
*
Visual (seeing/reading)
Auditory (listening/speaking)
Kinesthetic (hands-on/doing)
No clear preference
Other
How often does your child participate in class discussions or activities?
*
Never
1
2
3
4
Always
5
1 is Never, 5 is Always
Please rate your child's interest in the following subjects:
Rows
Not Interested
Somewhat Interested
Interested
Very Interested
Arts
26
27
28
29
Technology
30
31
32
33
Languages
34
35
36
37
Physical Education
38
39
40
41
Extracurricular Activities
42
43
44
45
Is there anything else you would like to share about your child's learning needs or preferences?
Submit Assessment
Should be Empty: