PARENT questionnaire: GETTING TO KNOW YOU

Please take a few moments to provide us with information that will allow us to best serve you and your student. Thank you!

Name of Parent Completing Form (Primary):

First Name

Last Name

Primary Parent Email

Primary Parent Cell

(###)

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We typically send reminders and detailed meeting recaps after each appointment. We prefer to copy a parent on these emails in order to keep the lines of communication open. However, some parents do not like to read all of the details and would prefer that we only contact them on a "need to know" basis. What is your preference?

Secondary Parent Name

First Name

Last Name

Secondary Parent Email

Secondary Parent Cell

(###)

###

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Many parents have multiple email addresses (i.e. work and personal). To prevent confusion down the line, are there any other email addresses you would like us to use for either parent? If so, please share them:

Part of your academic coaching package includes weekly text message updates to parents in addition to emailed meeting recaps. Please indicate your preference regarding text message updates.

Part of your academic coaching package also includes weekly text message updates for your student to remind them of important deadlines. Do we have permission to text message your student?

Yes

Is there another number that we should have on file to reach you if needed? For example, a work number, a home number, or both?

(###)

###

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Please provide information for at least one emergency contact person in case your student has an emergency while meeting with us alone and we cannot reach either parent:

Does your student have any medical issues about which we should be aware? For example, epilepsy.

Does your student have any religious or cultural needs about which we should be aware? For example, fasting during Ramadan.

Does your student have any allergies or other dietary restrictions about which we should be aware? For example, nut allergy.

Are there any aspects of your student's personality that you would like to share with our team?

Are there any sensitive family or personal issues with which your student has dealt or is currently facing? Oftentimes these come up during the coaching process and it can be helpful to know in advance. These can include eating disorders, social struggles, custody battles, and so on.