Student Information Form

Student Name *

Standard *

Place *

Fix Photograph of Student

Fix Photograph of Father

Fix Photograph of Mother

Has your child received a double promotion
YesNo

Has your child ever been identified as talented?
YesNo

Has your child ever been identified as having a special learning difficulty?
YesNo

Please indicate learning disability area.
ReadingLanguageMathematicsWriting

Has your child ever studied any languages other than English?
YesNo

Student living with
Both ParentsFatherMotherGuardian

If other than both parents
Parents separated / DivorcedFather deceasedMother deceased

Language(s) spoken at home

Is English spoken at home?
YesNo

Proficiency in English as a Second Language (Mark a tick in the appropriate box)

Written English
NoneAverageSatisfactoryProficient
Spoken English
NoneAverageSatisfactoryProficient
Reading English
NoneAverageSatisfactoryProficient

Social History (Please tick mark the appropriate descriptions)

Adjusts to new situations with easyHas never had to adjust to a new situationHas many friends likes to be active in schoolHas a Small group of friends

Please tick the expressions that describe your child.

Very ActiveVery QuietShyAverageAbove AverageSociableAggressiveStubbornOther

Person to call *

Relationship *

Tel. Number to cal!

Your Child Coming to School via
Parent-drop inSchool BusBi-Cycle

Do you ned a school bus facility?
YesNo

If yes, name of bus stop / locality*