• Date:

    Parent's Name:

    Student's Name:

    Dear Parent/Guardian:

    As the above student's parent/guardian, you are a member of the Instructional Support Team. Please answer the following questions and arrange to submit additional information you believe to be helpful in meeting your child's educational needs.

    1. Is there any information about your child that you want to share with the team?

    2. Are there any outside agency evaluation reports (i.e., psychological, medical, educational) that you would like to submit to the team for consideration of the student's educational needs? (Yes No)

    If yes, please identify the report(s) and arrange for the report(s) to be released to the school for the student's file.

    3. Please identify and describe some activities your child likes to do in his/her free time. What does your child do with his/her free time? What are some things he/she does well?

    4. What are some things you would like your child to be able to achieve one year from now as a result of his/her educational program?

    Instructional Support Team

    Parental Interview Information




    1. What are your child's strengths?

    2. What are his/her interests in school and home?

    3. What do you see as areas of concern?

    4. What is his/her activity after school?

    How much time does he/she spend on homework?

    Who helps with homework?

    Does he/she have a specific bedtime?

    Does he/she have specific chores?

    5. Is there anything in his/her medical history that could be relevant to his/her performance in school?

    6. How does he/she interact with: Peers?

    Other adults?


    Family members?

    7. Have there been any major changes in the family that may be impacting on your child's behavior and performance in school?

    8. What strategies have you found at home to be successful in working with your child?

    9. Is there anything else you feel we should know to help us in working with your child?