Parent Input Survey 1213-2

Parents. I would like to ask you to answer the following questions about your child that will be attending Palencia Elementary School next year. This information will help us with placing your child with the most appropriate teacher next year and will remain confidential with the Palencia Administrative staff only. Please feel free to call or email me if you have any questions about this survey. Please complete the survey by June 15th. Thank you. Don Campbell


A red asterisk (*) indicates required questions.

  1. Please list your child's legal FIRST Name.*


  1. Please list your child's legal LAST Name.*


  1. What grade level will your child be going INTO NEXT year?*
    Kindergarten
    First Grade
    Second Grade
    Third Grade
    Fourth Grade
    Fifth Grade


  1. How would you rate your child's academic ability in READING?*
    Reads above grade level
    Reads on grade level
    Struggles with Reading
    Not sure


  1. How would you rate your child's academic ability in MATH?*
    Excellent in Math
    Average in Math
    Struggles with Math
    Not sure


  1. How would you rate your child's motivation to attend school?*
    Loves going to school every day
    Likes school but not highly motivated
    Sometimes likes school and sometimes not
    Really doesn't like to go to school
    Not sure


  1. How would you rate your child's behavior in school?*
    Very well behavior all of the time
    Well behaved most of the time.
    Some minor behavior problems during the year
    Needs constant redirection for behavior
    Serious behavior issues.
    Not sure


  1. How would you rate your child's behavior AT HOME?
    Very well behavior all of the time
    Well behaved most of the time.
    Some minor behavior problems during the year
    Needs constant redirection for behavior
    Serious behavior issues.
    Not sure


  1. How would you rate your child's CREATIVITY?
    Very creative
    Somewhat creative
    Not very creative
    Not sure


  1. How would you rate your child's LEADERSHIP characteristics?
    Very much a leader among his peers
    Somewhat a leader
    Occasionally likes to lead
    Much more of a follower than a leader


  1. How would you rate your child's ORGANIZATIONAL skills?
    Extemely organized (gets dressed by him/herself, does his/her own homework without help, etc)
    Somewhat organized.
    Organized
    Not very organized
    Not sure


  1. How much time does your child spend on homework on an average per night?
    Less than 10 minutes
    10 to 20 minutes
    20 to 30 minutes
    30 to 40 minutes
    More than 40 minutes


  1. How satisfied are you with this previous year's teacher?
    Extremely satisfied
    Very satisfied
    Satisfied
    Not very satisfied
    Disappointed


  1. If you marked "Extremely satisfied" in question 13, please list your reasons below.


  1. If you marked "Not very satisfied" or "Disappointed" in question 13, please list your reasons below.


  1. Are there any health or physical issues we should know about your child?


  1. Are there any children that you would prefer not be in the same classroom with your child?


  1. Is there anything else we should know that would help us in placing your child with the most appropriate teacher?


  1. Name of parent/guardian submitting this information.


  1. Phone number of the person in question 19 in case we have any questions about the answers you provided.


  1. How will your child get to school most days?
    Riding their bike
    Walking
    Car
    Other


  1. Will your child be participating in our Extended Day after school program?
    Yes
    No
    Not sure





Mr. Campbell
Principal
Elementary
Saint Augustine, FL