FEEDBACK FORM PARENT/CHILD Please feel assured that all information will be treated as confidential and will only be used by staff in the best interests of your child. f | Student’s Name: Birth date: | Parent or Guardian's Name(s): How does your child feel about school? List your child's special interests (sports, church/community groups, swimming, books, music, etc.). Please list your child's strengths as a learner. Please list your child’s areas for growth (weaknesses) as a learner. What is the most important area of growth you would like for your child this year (reading, getting along with others, self confidence, etc.)? How would you describe your child’s social interactions? Please tell us any other information that we may need to know about your child that you have not already mentioned. OVERTt would be helpful if you would inform the teacher to situations that may affect your child during the school year (new baby, death, separation, divorce, hospitalization). Any information will be treated confidentially. Comments: Has your child had any significant (your opinion is the one that counts!) experience (hospitalization, accidental poisoning, head injury, fracture, death in the family, etc.), which you would like your son or daughter's teachers to be aware of so that they can be sensitive to that topic? (Other Comments: === = aa ae ee ee ee Date: Name of person filling out form: Relationship to child: