Have any of these jobs necessitated long absences from home Marital Status Single Married Divorced Separated Widowed Deceased If separated, to whom must Both Father Only Mother Only documentation be sent? If divorced, who has legal custody? Father Mother If divorced does the other parent have Yes No access and visiting rights Is this child: Biological Fostered Adopted Siblings (In Chronological Age) Name Age School Class Academic progress Position of child to be assessed, within the family: How do you your child? “see” It is very important that each parent fill in this section separately as it contains valuable information. This is not the place to discuss your present concerns (see page 8). Just describe your child as he/she appears to you. Father’s Description Mother’s Description
Have any of these jobs necessitated long absences from home Marital Status Single Married Divorced Separated Widowed Deceased If separated, to whom must documentation be sent? Both Father Only Mother Only If divorced, who has legal custody? Father Mother If divorced does the other parent have access and visiting rights Yes No Is this child: Biological Fostered Adopted Siblings (In Chronological Age) Name Age School Class Academic progress Position of child to be assessed, within the family: How do you “see” your child? It is very important that each parent fill in this section separately as it contains valuable information. This is not the place to discuss your present concerns (see page 8). Just describe your child as he/she appears to you. Father’s Description Mother’s Description
Questionnaire-January-2018.docx