Student Name:

Parent Name:

Needs Assessment

Please fill out and send back with student 

1. What is your name? ______________________

Any nicknames? _________________________

2. What is your occupation? What do your duties consist of? ______________________________

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3. What are your hobbies/special interests?

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4. Would you be willing to showcase your hobbies/interests in your child’s classroom?

Yes No Maybe (circle one)
5. What common interests/talents do you and your child share?
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6. What was your favorite subject in school? Why?

______________________________________________________________________________

7. How you consider your and your child’s relationship?

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8. How important is your child’s education to you?
______________________________________________________________________________
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9. Do you feel that your child does better in a family oriented environment?
Yes/No (circle one)
Explain:
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10. Would you say that your parents’ were involved throughout your educational experience?
Yes No Maybe (circle one)
Reason:
______________________________________________________________________________
______________________________________________________________________________

11. Do you have any concerns about your child’s education?

Yes/No (circle one)
Explain:
______________________________________________________________________________
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12. In what way do you think you can better your child’s education?
______________________________________________________________________________
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13. Do you consider yourself as being a “hands-on” parent?

Yes/No (circle one)
Explain:
______________________________________________________________________________

14. What can you do to be more involved in your child’s education?

______________________________________________________________________________
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15. How do you see yourself participating in your child’s classroom?

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Thank you for your completion!