CC003 PERFORMANCE TASK ANALYSIS

Document #2: John Hall: Beginning of the Year Questionnaire

Tell Me A Little Bit About Your Child

All information will be kept confidential.

Your Name: Stephanie Hall___________________________________________________________

Your Child’s Name: Jonathan Hall­______________________________________________________

Nicknames: Jonny, Jon_______________________________________________________________

Does your child have allergies or any other health conditions we should be aware of?

He has illness-induced asthma and is allergic to strawberries._______________________________

_________________________________________________________________________________

What is the most important thing I should know about your child?

He is painfully shy around new children and adults, but he can be talkative once he gets__________ comfortable with someone. One-on-one interactions are the best way to get him out of his shell._

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Briefly describe your child’s personality.

Jonny is very shy. He prefers to play by himself instead of with other children. He is very curious and

will ask a lot of questions, once he is familiar with a person.__________________________________

___________________________________________________________________________________

What are some of your child’s favorite activities?

He likes to build things with Legos and read books with pictures of dinosaurs in them______________

___________________________________________________________________________________

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How will your child go home from school (bus, carpool, other)? By car­­__________________________

Is there anyone else who will regularly pick up your child from school?

No_________________________________________________________________________________

Please share any other information that you think will be important for me to know.

Jonny works best in a structured environment, and he can sometimes have difficulty with unstructured time. He doesn’t usually have tantrums, but when he does, the best way to handle it is to give him____ activities that he can do by alone--puzzles, blocks, coloring books, etc.____________________________

Tell Me A Little Bit About You and Your Family

Do you speak another language at home? If so, which one?

­No________________________________________________________________________

Do you read to your child? How often?

Yes, every night before he goes to bed.___________________________________________

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Who else lives at your house (grandparents, siblings, pets, etc.)?

­­No one else aside from me, Jonny, and my husband. We have two cats.­_________________

___________________________________________________________________________

What is your preferred method of communication (email, phone call, note, meeting, etc.)?

Phone call, but email, meetings, and notes are all fine.______________________________

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How would you like to be involved in our classroom? Please check all that apply.

_X_ Cut out materials at home

_X_ Help at class parties/events

_X_ Help make art projects and crafts

_X_ Attend field trips

_X_ Other I’m a stay-at-home parent, so if you need an extra adult, I’m always__

available and willing to help. Please don’t hesitate to ask.____________

___________________________________________________________

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