Diverse Education

Questionnaire

Home

Diverse Education Questionnaire

Diverse Education Form

Details

Student First Name

Student Last Name

Date of Birth

Year Level Entering

Campus

Previous School / ELC

Parent/Guardian First Name

Parent/Guardian Last Name

Preferred Contact Details

Medical & Developmental History

1. Please specify any medical conditions your child has been diagnosed with:

2. Please specify any diagnosed learning disabilities or developmental delays your child has been diagnosed with

3. Which [if any] therapy or intervention services has your child received or engaged with? (e.g., Speech Therapy, Occupational Therapy, Psychology)

4. Please provide details of any regular medication your child takes

Managing Attention & Focus

1. How does your child manage getting started on a task?

2. How does your child manage switching between tasks?

3. Please describe the optimal environment or conditions for your child to manage following instructions given by an adult.

4. Please describe the optimal environment or conditions for your child to manage completing tasks, as requested by adults?

Routines

1. How important is it for your child have a regular daily routine at home?

2. What does their current daily routine in the morning and evening look like?

3. How does your child respond to changes in their routine?

4. Which strategies do you use at home to help your child transition between activities?

Co-regulation

1. How does your child respond when faced with challenges, or experience big emotions or frustrations?

2. How does your child respond when you need to say "no" to something they want, or when things don’t go their way?

3. Which strategies do you use to help your child regulate their emotions when they become dysregulated?

Social Interaction

1. How easily does your child make new friends, or do they prefer their own company?

2. Please describe your child’s friendship preferences. [i.e. do they prefer a large group of friends, a few close friends, to be alone, age peers, older/younger students, or adults]

3. How does your child interact with peers in group settings?

Confidence & Interdependence

1. Please describe how your child approaches new situations or tasks?

2. To what extent is your child eager to try new activities or experiences?

3. To what extent does your child require additional encouragement to take risks or try new things?

Previous School/ELC Experience

1. Please describe any SSO support, intervention programs, modifications or adjustments provided for your child, in their previous school or ELC?

2. Were there any particular strategies that worked well in supporting your child’s learning at their previous school or ELC?

3. Is there anything that did not work well or that you would like to see improved in their previous support plan?

Parental Concerns & Expectations

1. Please describe your main concerns regarding your child’s schooling and support needs:

2. What are your expectations for SVCC in supporting your child’s additional needs?

3. Which other information you would like to share would help us to support your child effectively?

Documentation & Reports

1. Which reports or assessments from therapists, medical professionals, or previous schools, have you attached to this questionnaire?

Upload documentation

Choose File

2. Please detail any upcoming assessment or review that the school should be aware of?