Speech Therapy Parent Questionnaire gather information interests form

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Speech Therapy / Special Education Teacher PARENT QUESTIONNAIRE to gather information / interests about student

This is such a simple yet important part of speech therapy and other special educators especially for those students that are nonverbal or minimally verbal. That is gathering information about the student pertaining to the student's interests, likes/dislikes, family members, etc. Knowing this information allows you to make materials that are important and meaningful to the child, whether it be a biographical book/sentences, flash cards with words about their favorite things (encouraging utterances!), and finding out what reinforcers may work.

Great for students with autism, special needs, nonverbal, minimally verbal, Deaf/Hard of Hearing, etc.

I have 4 different presentations of the form included in this download. Two are specifically for speech therapy and the other two can be used for non-speech therapy educators.

Here are questions on the form:

Student’s Name: _________________ Date: __________
Please fill out the form below about your child . We plan to include this Information in speech therapy activities throughout the year. This may help your child express himself/herself in areas that are meaningful to him/her. If you have pictures of your child, family members, pets, events, etc., please send them in.

List FAMILY MEMBERS in your child’s life and how related:
_________________________ 2. __________________________
_________________________ 4. __________________________
_________________________ 6. __________________________
7. _________________________ 8.. __________________________

List your child’s favorite TOYS / BOOKS: ________________________________________________________________________________________________________________________
List your child’s favorite PLACES:
______________________________________________________________________________________________________________________
List your child’s favorite FOOD/DRINKS:
:______________________________________________________________________________________________________________________
List your child’s favorite THIINGS TO DO:
______________________________________________________________________________________________________________________
List your child’s favorite MOVIES / TV SHOWS::
______________________________________________________________________________________________________________________
List activities/tasks/things your child DISLIKES:
______________________________________________________________________________________________________________________



Total Pages
7
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N/A
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Speech Therapy Parent Questionnaire gather information int
Speech Therapy Parent Questionnaire gather information int
Speech Therapy Parent Questionnaire gather information int
Speech Therapy Parent Questionnaire gather information int