Name of Student: Name of Teacher/s Completing Questionnaire: Date:

Child Find Questionnaire

1. Please describe the students strengths and interests

2. Briefly describe your concerns regarding this student

3. Please describe the current situation in the following areas: A. Describe how the student interacts with staff:

B. Describe how the student interacts with his/her peers:

C. Describe where the student usually sits or sets up for the day:

D. Describe the students ability to attend to tasks and focus on work. What support has been provided?

E. Describe the amount of language support the student needs (ELL, difficulty with following directions, difficulty with expressing feelings/needs)

F. Sensory Processing (hearing, vision, tactile issues)

4. Are the parents involved in the students life? Do you have a relationship with their parents? Do you regularly communicate with the parents? If so, what does the parent have to say about your concerns?

5. Is there any medical or mental health information that is relevant to your concerns regarding this student? Does the student have a history of juvenile delinquency? Probation officer? Social worker?

6. Has the student disclosed any other information that might pertain to your concern?