- Child's name*
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- How much time do you personally spend reading each day?*
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- What kind of materials do you read at home?*
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- Do you have a home library that includes children literature that is easy access for your child?*
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- How long do you read with your child each day?*
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- Do you and your child take time to discuss books/movies you have experienced together?*
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- What activities does your family enjoy doing together?*
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- Does your child have access to a computer in your home?*
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- How much time does your child spend watching television/playing video games each day?*
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- How long do you think daily homework assignments should take your child to complete?*
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- How many hours of sleep does your child get each night?*
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- When and where does you child complete his/her homework?*
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- Considering your child's ability, rate your child's academic strengths from 1 to 4, with 4 being the strongest.*
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- What's the best way to communicate with you about your child?*
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- What is a convenient time for a parent-teacher conference?*
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- What is your email address?
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- Is there anything you'd like me to know about your child?
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- I'd like to help by...
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