Teacher - Psych Ed Questionnaire

Interview Questionnaire for Teachers

Please note the information provided in this questionnaire may be released to the parent upon request and included in any subsequent report. Please do not include any information that you do not wish to be shared with the family.

PLEASE SCREENSHOT EACH PAGE AS YOU GO INCASE OF SUBMISSION ERROR TO AVOID LOSING COMPLETED INFORMATION

We will be meeting with a student of yours in the near future for complete a learning assessment, and we would appreciate your time in filling in this brief questionnaire in order to obtain information about the child's learning and behaviours within your setting. This information is of great value. Thank you.

Child's Name (First name & Surname)

How long have you known this child?

Year level of child

Your Name

Name of School

Are you happy to be contacted, with the parent's permission, and if so what number is best?

Please describe this student's learning ability/academic progress. Do you have any academic or cognitive concerns?

Please describe the student's concentration, attention/focus and organisational skills? Do you have any concerns?

Is the student receiving any extra learning support/extra support programs?

Describe the student's social skills and friendship circle. Do you have any concerns in this area?

Do you have any concerns regarding the student's mood/mental health

e.g. anxiety, depression symptoms, aggression

Other comments/concerns

Thankyou for you time.