Reading Sprouts | New Student Questionnaire

Step 1 of 10

About your family

Let’s start with the basics.

Student name

Preferred name / nickname

Age

Date of birth

Grade

School

Parent / guardian

Parent/guardian name

Best phone number

Email

Step 2 of 10

Your child as a reader

Tell us how reading feels at home.

What types of books or topics does your child enjoy?

What does your child feel most confident doing when reading?

Step 3 of 10

Reading & phonics skills

No wrong answers. This just helps us plan.

Are there specific sounds, letters, words, or phonics patterns your child has difficulty with?

Step 4 of 10

Reading behaviors

What do you notice when they hit a tricky word?

Does your child have difficulty staying focused during reading?

YesNoSometimes

If yes, please describe:

Step 5 of 10

Learning needs & school history

Share only what you’re comfortable with. It stays between you and your tutor.

Has your child ever been identified as having a learning disability or learning difference?

NoYesCurrently being evaluated

If yes, please share any information you feel would help us support your child:

Has your child ever received additional support for reading, speech, language, or learning?

NoYes

If yes, please describe:

Does your child currently have an IEP, 504 Plan, intervention plan, or other educational support plan?

NoYesNot sure

Are there any accommodations or strategies used at school that work particularly well for your child?

Step 6 of 10

Comfort, emotions & calming

We want every student to feel safe, comfortable, and successful at Reading Sprouts.

What situations tend to make your child frustrated, overwhelmed, nervous, or upset during learning?

Is there anything we should know about your child’s emotional or sensory needs?

Step 7 of 10

Reading & phonics goals

Where would you love to see your reader grow?

What are your top 3 goals for your child?

Goal 1

Goal 2

Goal 3

Is there a specific reading level, skill, school goal, or milestone you would like your child to reach?

Step 8 of 10

Your child’s strengths

The best lessons start with what they already love.

What are your child’s greatest strengths?

What does your child enjoy learning about?

What makes your child excited to learn?

Step 9 of 10

Home reading

Small habits add up.

How much time would you realistically like your child to spend reading or practicing at home each week?

10–15 minutes15–30 minutes30–60 minutesMore than 1 hour

Would you like Reading Sprouts to provide suggested activities or reading practice for home?

YesNo

Step 10 of 10

Almost done!

One last thing, then you’re all set.

Is there anything else you would like your Reading Sprouts tutor to know about your child?

I understand that the information provided will help Reading Sprouts create individualized reading and phonics instruction for my child. *

Parent/guardian name (typed as signature)

Date