Parent Interview Questionnaire


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

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