DMS Parent Interview Survey

DMS Parent Interview

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1.	What is your child's name?*

2.	What is your relationship to the child?*

What is your current mailing address?*

House Number
or PO BOX
Street Name
City
State
Zip Code

What are your important phone #'s?*

Home #
Parent Cell#
Parent Work#
Parent Place of Employment

5.	What is your email address? If you have no email address please feel free to come to DMS - Monday - Thursday from 4-7 pm. Mrs. Egle can help you sign up for free email.

6.	Please list siblings in the home and their grade level/age.

7.	What would you like for me to know about your child?

8.	What strategies have previous teachers used that have worked well for your child?

9.	Does your child have any health problems or other circumstances that might interfere with his/her progress in school?

10.	Do you have any other suggestions to help your child be successful?

What teachers do you want this report to go to??*

		Heiens		Diaczenko		Lemieux		Furrh		Alexander		Tally		Archer		Crawford		Dennard		McDonald		Willis		S. Paque		Egle		McMahan		Sneed		McNeil		Reed		Williams		Howland		Hensley		Aaron		Lemons		Hinson		Jean		Estel		Hornsby		Grimes		Edwards		Mattison		Blessing		McComis
Teachers Name

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