Student Info

Student Information Student name _______________________________ Preferred name _______________ Date of birth _____________ Mother (or Guardian responsible for student)’s Name ____________________________

Address ________________________________________________________________ Home/Cell Phone ___________________________Work Phone ___________________ E-mail ______________________________ @_______________________ Best time to be reached: ___________________________________________________ Place of work____________________________ Would you be willing to share your work and/or resources with our class? _______ Father’s Name __________________________________________________________ Address ________________________________________________________________ Home/Cell Phone ___________________________Work Phone ___________________ E-mail ______________________________ @_______________________ Best time and way to be reached: ____________________________________________ Place of work____________________________________________________________ Would you be willing to share your work and/or resources with our class? _______

Emergency Contact Name _________________________________________________ Address ________________________________________________________________ Home Phone ______________________________ Work Phone ___________________

What kind of things is your student interested in? (This may include talents, TV shows, games, favorite activities, or anything else you would like to share with me.) ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Student’s Medical Concerns/Allergies/Medications etc. (Please explain, this can include any health problems that might affect his or her behavior or academic progress): ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ What are your dreams for your student? (This year and far future) ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ What are your fears for your student? (This year and far future) ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Special days your family celebrates. Would you be willing to share information on these with our class? ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________

What general questions do you have about classroom curriculum, standards, evaluation techniques, or procedures? ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________

Does your child still take naps? ________ If so, what time of day? ______________

What would you like to see a lot of this school year? (Please circle all that apply) Newsletters

Behavioral Notes Home

Field trips

Parent/Teacher Conferences

Family Nights and Workshops Parent Resources

Family Projects Homework

Phone Calls Home

Classroom Website

Specials (PE, art, etc.) Classroom Centers

Pictures

Portfolios

Other _____________________________

Please circle any ways listed below you or your family might be willing to contribute to our classroom. Technical Support

Food Donations

Voice Record Reading Books Aloud Chaperone Field Trips

Supply Donations

Volunteer Time

Create Classroom Decorations

Plan Family Nights

PTA

Classroom Preparations

Other ______________________________________________________________

Thank you for helping me get to know your student! Please see me if you have any questions or you information changes through the year!