Upper Elementary Admissions – Family Questionnaire For all families considering Parkside for the next school year, please complete and submit this questionnaire before your required classroom observation and administration meeting. Child's Name:* First Last Date of Birth:* MM DD YYYYGenderUnspecifiedBoyGirlUpload Child's Picture*Upload a recent picture of your child (family photos are accepted as well).Parents'/Guardians' Names and Occupations:*Preferred Email Address* Do both parents/guardians live in the same house?*YesNoNames and ages of siblings:*What is your child's first language?*What other languages are spoken in the home?*School BackgroundPlease list the name and dates of attendance of all schools that your child has attended, describe their experience, and include your reason for leaving.Name of School:*Name of School:Name of School:At what age did your child begin to read?*Please describe your child's reading level and list the books they are currently reading.*Does your child have mastery of addition and multiplication tables?*How would you describe your child's grasp of mathematics in general?*What would you consider to be your child's academic strengths and challenges?*What would you consider to be your child's social strengths and challenges?*Why are you seeking Parkside's Upper Elementary Program?*How did you find out about Parkside?*Online SearchSchool Street SignPublicationParkside Family (Current or Alumni)OtherWhat is your family and child's history with prompt and consistant attendance?*Do you plan to have your child out of school for travel or other reasons?*UPE has weekly work assignments with due dates. How does your child handle time management?*Is your child willing to work in content areas that may be challenging for them?*Homework is a requirement in UPE. It can be from one and a half hours to upwards of three hours a week depending on the child and home environment. Has your child had homework before, and if so, how well did they cope?*Describe your child's screen time (TV, video, computer, iPad, etc) - when and how long?*What three words best describe your child?*What are your child's interests and favorite activities?*Anything significant in your child's medical history we should know about?*Beginning with the 2020-21 school year, all students enrolled at Parkside must be up to date on their immunizations or have a qualifying medical exemption that prevents full compliance.*My child is up to date on their immunizations.My child has a medical exemption for one or more immunizations.Has your child been professionally evaluated (speech, SI, OT, etc)?*YesNoHas your child received or are they currently receiving outside tutoring, support, or therapy?*YesNoIf yes, please explain and include suggestions for how we can best support your child in the classroom. Please also provide a copy of any current IEP, 504, or other plan for accommodations.Please list anything else you would like to tell us about your child.CommentsThis field is for validation purposes and should be left unchanged.