Parent Interview Questionnaire
A parent interview questionnaire is an important tool used during admission of students at school. The school uses the questionnaire to collect vital information about the child. It helps them to gather background information about the child before admission. The parent interview questionnaire also contains details about the parents such as occupation. In most cases, the mother fills in the questionnaire even though the dad may also fill it in. Below is a sample parent interview questionnaire.
Sample Parent Interview Questionnaire
Date __________________________________
Child’s name ____________________________
Male ____ Female _________
Child’s date of birth ______________________
Home phone ___________________________
Parent work phone ______________________
Street address __________________________
Mailing address ________________________
City __________________________________
State _________________________________
Zip Code ______________________________
Name of father ____________________________
Age _________________________________
Occupation ___________________________
Name of mother _______________________
Age _________________________________
Occupation ____________________________
Are there any serious concerns about your child? Yes __________ No ______________
If yes explain ___________________________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________________________________
Did the mother experience anything unusual about the pregnancy with this child?
Yes ___________ No ________
If yes explain ____________________________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________________________________
At what age did your child begin
Walking ____________________
Speaking _____________________
Did any of the following occur during your child’s birth? (Tick where appropriate)
Transfusion ______________
Premature birth ____________
Breech birth _______________
Oxygen problem ____________
Fetal distress _______________
Blood incompatibility _________
Caesarean section ___________
Did the child experience any difficulty growing up? Yes ____ No _________
If yes explain ___________________________________________________________
________________________________________________________________________________________________________________________________________________
Has your child experienced any traumatic events? ___________
If yes explain ___________________________________________________________
________________________________________________________________________________________________________________________________________________
What language is spoken frequently in your home? ____________________________
(Give yes or no answer) Does your child
Whine _____________________
Seem unusually quiet _____________
Have temper tantrums _____________
Category: Interview Questionnaire