Student name____________________________

Parent name_____________________________

Day phone:___________________

Your impressions of what helps your student go forward provide the most important information to help in matching the student to an educational model. Please answer the following, which will help me to incorporate your ideas into my own comments.

Who has been the most influential person outside the family for whom your student performs in a positive way? What was this person like?

What does appear to motivate him or her?( Social acceptance, teacher approval, freedom from outside controls, etc)

What kind of student was this child in early elementary school? Did any difficulties show up in school that surprised you as a parent who knows your child best?

How does this student relate to friends? (leader, follower, changes friends often, few friends, etc. Are there any long-standing relationships?

What talents do you see in this student which make you think of a future career?

How is this student's planning ability? How good is his or her independent time management? How much help is needed in scheduling to meet deadlines?

Has religious training been a part of his or her upbringing? (i.e. church or temple youth groups, service to others, etc.)

If you could design an ideal school for your particular student what would it be like?

Please note any other information which you think is relevant: If you have behavioral concerns, it is often helpful to both you and me for you to prioritize them in order of importance. You may fax this to 847-234-7227, or mail it to Jeanette Spires, 111 Fallstone Ct., Lake Forest, IL 60045 e-mail: jebspi@aol.com