Community HELP Parent Questionnaire Community HELP Parent Questionnaire Child's Name(Required) First Last Child's Date of Birth(Required) MM slash DD slash YYYY Your Name(Required) First Last Relationship to Child Your primary phone number(Required)Please list any other phone numbers (if applicable) that we can use to contact you.What learning problems has your child been diagnosed with?(Required)Is there a family history of learning problems or attentional disorders?(Required)What areas are you seeking help for?(Required) Add RemoveWhat has been done/is being done to help your child in school?Child's abilitiesPlease rank your child’s ability in the following areas. Playing Team Sports Excellent Very Good Average Difficult Very Difficult Playing Individual Sports Excellent Very Good Average Difficult Very Difficult Climbing, running, jumping Excellent Very Good Average Difficult Very Difficult Catching, throwing, kicking Excellent Very Good Average Difficult Very Difficult Painting Excellent Very Good Average Difficult Very Difficult Drawing Excellent Very Good Average Difficult Very Difficult Crafts Excellent Very Good Average Difficult Very Difficult Playing with building toys Excellent Very Good Average Difficult Very Difficult Puzzles Excellent Very Good Average Difficult Very Difficult Playing board games Excellent Very Good Average Difficult Very Difficult Learning rules to games Excellent Very Good Average Difficult Very Difficult Playing with same age kids Excellent Very Good Average Difficult Very Difficult Playing with older children Excellent Very Good Average Difficult Very Difficult Following simple directions at home Excellent Very Good Average Difficult Very Difficult Playing with younger kids Excellent Very Good Average Difficult Very Difficult Following complicated or multiple directions at home Excellent Very Good Average Difficult Very Difficult (Get dressed, tie your shoes, and grab your backpack, or get me the red bowl in the cabinet by the stove).Speaking clearly Excellent Very Good Average Difficult Very Difficult Explaining things Excellent Very Good Average Difficult Very Difficult Remembering where to find things Excellent Very Good Average Difficult Very Difficult Remembering messages Excellent Very Good Average Difficult Very Difficult Remembering how to get places Excellent Very Good Average Difficult Very Difficult Telling left from right Excellent Very Good Average Difficult Very Difficult Telling time Excellent Very Good Average Difficult Very Difficult Using their imagination Excellent Very Good Average Difficult Very Difficult Reading words Excellent Very Good Average Difficult Very Difficult Sounding out words Excellent Very Good Average Difficult Very Difficult Remembering sight words Excellent Very Good Average Difficult Very Difficult Understanding what they read Excellent Very Good Average Difficult Very Difficult Understanding what he/she read Excellent Very Good Average Difficult Very Difficult Reading aloud Excellent Very Good Average Difficult Very Difficult Figuring out what new words mean Excellent Very Good Average Difficult Very Difficult Remembering what they have read Excellent Very Good Average Difficult Very Difficult Handwriting Excellent Very Good Average Difficult Very Difficult Writing sentences/paragraphs Excellent Very Good Average Difficult Very Difficult Writing fast enough Excellent Very Good Average Difficult Very Difficult Spelling test words Excellent Very Good Average Difficult Very Difficult Everyday spelling Excellent Very Good Average Difficult Very Difficult Learning math Excellent Very Good Average Difficult Very Difficult Remembering math facts Excellent Very Good Average Difficult Very Difficult Avoiding careless math mistakes Excellent Very Good Average Difficult Very Difficult (Adding instead of subtracting, forgetting to carry)Completing homework Excellent Very Good Average Difficult Very Difficult Bringing homework home Excellent Very Good Average Difficult Very Difficult Turing in homework Excellent Very Good Average Difficult Very Difficult Knowing what to study Excellent Very Good Average Difficult Very Difficult Learning new words Excellent Very Good Average Difficult Very Difficult Memorizing things for school Excellent Very Good Average Difficult Very Difficult Music Excellent Very Good Average Difficult Very Difficult Art Excellent Very Good Average Difficult Very Difficult Other questionsWhat is your child’s favorite subject? Why do you think it is their favorite?What is your child’s least favorite subject? Why do you think it is their least favorite?What activities does your child like to do for fun?Does your child participate in any after school activities (sports, scouting, church groups)How does your child feel about school?What is homework time like at your house?Do you have any ideas or suggestions as to what works well for you child?Anything else we should know?