Packanack School Reading Survey
Parent's Form - Students Reading Survey
Please complete this form as accurately as possible.
Optional Fields are marked with a
red asterisk*
Important information is
marked in red.
Personal Information
Student's Last Name
Student's First Name
Grade
Choose One
First
Second
Third
Fourth
Fifth
Gender
Female
Male
Date Of Birth
mm/dd/yyyy
Does Your Child Wear
No
Yes
What language does your child speak at home?
Choose One
English
Spanish
Italian
Korean
Chinese
Japanese
Russian
Other
Academic Information
Please check all services your child has received in the past.
Speech
E.S.L.
Basic Skills
Resource Room
On average how often does your child read on his own per week?
Often
Sometimes
Rarely
Never
Please check all that apply to your child's reading.
Reads with expression
Points to words as he or she reads
Moves his/her head as he/she reads
Comprehend what is read
Pauses at punctuation marks
Skips unknown words
Tries sounding out unknown words
Has difficulty recalling details
What would you say are your child's strengths.
What would you say is an area that you child needs to improve on?
*
Comments
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Last Updated: 12/18/2007