Hope Academy Lower School (K-5) Teacher Questionnaire

Lower School (K-5) Teacher Questionnaire

This questionnaire is designed to assist us in determining if/how this student might fit into our classroom and school environment. Your responses will be kept confidential and will not become a part of the student's permanent records. Thank you in advance for answering the questions below and assisting us in the application process.
Student Information:
Student's Name *

First Name Last Name
Student's Current School *
Grade Applying For *
Student's Current Grade: *
Teacher's Information:
Teacher's Name *

First Name Last Name
Teacher's Phone Number *

Area Code Phone Number
Teacher's Email *
example@example.com

Approximately how often has this child been absent this school year? *

	1	2	3	4	5

1 is Frequently (12+ days), 5 is Rarely (Less than 4 days)

Approximately how often has this child been Tardy this school year? *

	1	2	3	4	5

1 is Frequently (12+ days), 5 is Rarely (Less than 4 days)

How academically prepared is this child for the grade in which they are applying? *

	1	2	3	4	5

1 is Not Prepared, 5 is Exceptionally prepared

How well does this child manage himself/herself behaviorally? *

	1	2	3	4	5

1 is Poorly, 5 is Exceptionally

How well does this child interact socially with peers? *

	1	2	3	4	5

1 is Poorly, 5 is Exceptionally

Please explain your rating: *
Has this child required any formal disciplinary action (Detention, expulsion, suspension)? *

Yes No
If yes, Please explain:

How supportive and involved are this child's parents? *

	1	2	3	4	5

1 is Not Involved, 5 is Highly Involved

Please rate the child's English proficiency: *

	1	2	3	4	5

1 is Poor, 5 is Exceptional

Please explain your rating: *
Does this student have an IEP, 504 Plan or Recieve Title I, Title III (ELL), counselor visits, etc? *

Yes No
If yes, please explain: *
Please provide other comments that can help us determine if this can be a mutually beneficial fit: *
Should be Empty:

Lower School (K-5) Teacher Questionnaire