Whole Child Assessment Questionnaire Form
Please complete this questionnaire to provide a holistic view of the child's development and well-being. Your responses help us better understand the child's strengths and areas for growth.
Overall Engagement in Classroom Activities
*
Not engaged
1
2
3
4
Highly engaged
5
1 is Not engaged, 5 is Highly engaged
Emotional Regulation
*
Rarely manages emotions
1
2
3
4
Consistently manages emotions
5
1 is Rarely manages emotions, 5 is Consistently manages emotions
Social Interactions with Peers
*
Rarely interacts
1
2
3
4
Very socially engaged
5
1 is Rarely interacts, 5 is Very socially engaged
Approach to Problem Solving
*
Avoids challenges
Needs encouragement
Attempts independently
Persists through challenges
Self-Confidence in New Situations
*
Not confident
1
2
3
4
Very confident
5
1 is Not confident, 5 is Very confident
Physical Activity Level
*
Low
Moderate
High
Interest in Creative Activities
*
Not interested
1
2
3
4
Highly interested
5
1 is Not interested, 5 is Highly interested
Learning Behaviors Assessment
*
Rows
Never
Sometimes
Often
Always
Follows instructions
1
2
3
4
Completes tasks
5
6
7
8
Stays focused
9
10
11
12
Asks for help when needed
13
14
15
16
Preferred Learning Style
Visual
Auditory
Kinesthetic
Other
Additional Comments (optional)
Submit Assessment
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