Parent Questionnaire

Question Title

* 1. Read each scenario and rate how often you feel as described.

	Never	Sometimes	Often
My child/student works hard at school but doesn't succeed as much as I'd like.	My child/student works hard at school but doesn't succeed as much as I'd like. Never	My child/student works hard at school but doesn't succeed as much as I'd like. Sometimes	My child/student works hard at school but doesn't succeed as much as I'd like. Often
I feel like my child/student needs clearer dreams and goals.	I feel like my child/student needs clearer dreams and goals. Never	I feel like my child/student needs clearer dreams and goals. Sometimes	I feel like my child/student needs clearer dreams and goals. Often
My child/student doesn't make regular progress toward his/her dreams and goals.	My child/student doesn't make regular progress toward his/her dreams and goals. Never	My child/student doesn't make regular progress toward his/her dreams and goals. Sometimes	My child/student doesn't make regular progress toward his/her dreams and goals. Often
I feel like s/he could do a lot more most days.	I feel like s/he could do a lot more most days. Never	I feel like s/he could do a lot more most days. Sometimes	I feel like s/he could do a lot more most days. Often
I believe my child/student has a lot of potential but doesn't know how to use/apply it.	I believe my child/student has a lot of potential but doesn't know how to use/apply it. Never	I believe my child/student has a lot of potential but doesn't know how to use/apply it. Sometimes	I believe my child/student has a lot of potential but doesn't know how to use/apply it. Often
In my heart, I know s/he's not really trying hard enough.	In my heart, I know s/he's not really trying hard enough. Never	In my heart, I know s/he's not really trying hard enough. Sometimes	In my heart, I know s/he's not really trying hard enough. Often
My child/student has some dreams & goals but little idea HOW to achieve them.	My child/student has some dreams & goals but little idea HOW to achieve them. Never	My child/student has some dreams & goals but little idea HOW to achieve them. Sometimes	My child/student has some dreams & goals but little idea HOW to achieve them. Often
I see a beautiful future for my child/student - s/he just needs a roadmap.	I see a beautiful future for my child/student - s/he just needs a roadmap. Never	I see a beautiful future for my child/student - s/he just needs a roadmap. Sometimes	I see a beautiful future for my child/student - s/he just needs a roadmap. Often
My child/student doesn't manage time well - s/he usually doesn't complete what s/he needs to.	My child/student doesn't manage time well - s/he usually doesn't complete what s/he needs to. Never	My child/student doesn't manage time well - s/he usually doesn't complete what s/he needs to. Sometimes	My child/student doesn't manage time well - s/he usually doesn't complete what s/he needs to. Often
My child/student never has enough time to do all the things s/he wants or needs.	My child/student never has enough time to do all the things s/he wants or needs. Never	My child/student never has enough time to do all the things s/he wants or needs. Sometimes	My child/student never has enough time to do all the things s/he wants or needs. Often

Question Title

* 2. I am requesting information for my...

Son

Daughter

Student I teach/advise

Question Title

* 3. Enter your contact information

Name

Email Address

Phone Number