Family History Survey
Your E-mail Address (parent/guardian)
*
example@example.com
Your Student's Name
*
First Name
Last Name
School Name
*
Please Select
Country View
Core Knowledge Charter
Glacier Edge
New Century Charter
Stoner Prairie
Sugar Creek
Verona Area International School
Grade Level
*
Please Select
K
1
2
3
4
5
What is your student’s interest in reading and literacy activities such as reading independently, having books or stories read to them, and rhyming activities?
*
Very uninterested
Uninterested
Somewhat interested
Interested
Very interested
Prior to attending VASD, has your student ever been recommended for summer reading intervention or support? If so, who made the recommendation?
*
Has your student ever been recommended to receive reading or writing tutoring services outside of the school setting? If so, who made the recommendation?
*
Has anyone in the student’s family been diagnosed with dyslexia, or experienced difficulties with reading and spelling (either as a child or adult)?
*
Yes
No
Submit
Should be Empty: