Parent Questionnaire

Choose one answer under each question to indicate how often the behavior is exhibited in the individual’s daily life. The results of the survey will be used by Trafford Speech, Language & Literary Services Inc. to initiate a discussion with you about your observations, and a free assessment will be set up to be done on a computer at their leisure. It will take about 20 minutes to complete and the results will be shared when completed.   These results will help us to understand the individual’s learning strengths and weaknesses and to make recommendations.  
Understands what you say
Field is required!
Field is required!
Needs instructions repeated
Field is required!
Field is required!
Understands jokes
Field is required!
Field is required!
Understands long sentences
Field is required!
Field is required!
Needs questions repeated
Field is required!
Field is required!
Can retell a story in the right order
Field is required!
Field is required!
Can finish long sentences
Field is required!
Field is required!
Has trouble saying the same thing in a different way (rephrasing)
Field is required!
Field is required!
Has trouble finding the right word
Field is required!
Field is required!
Pronounces common words correctly
Field is required!
Field is required!
Gets confused in noisy places
Field is required!
Field is required!
Has conversations with others
Field is required!
Field is required!
Has behavior problems
Field is required!
Field is required!
Lacks self-confidence
Field is required!
Field is required!
Avoids group activities
Field is required!
Field is required!
Has trouble paying attention
Field is required!
Field is required!
Has trouble sounding out words
Field is required!
Field is required!
Has trouble reading
Field is required!
Field is required!
Can tell you about the events of his/her school day
Field is required!
Field is required!

About You

First Name
Your First Name
Please provide your first name
Please provide your first name
Phone Number
Your Phone number
Please provide your phone number
Please provide your phone number
Last Name
Your Last Name
Please provide your last name
Please provide your last name
Email Address
Your Email Address
Please provide your email address
Please provide your email address
How do you prefer to be contacted?
Field is required!
Field is required!
Student Name
Student Name
Field is required!
Field is required!
Your relationship to the student
Field is required!
Field is required!
Student's Age
Field is required!
Field is required!
Student's Grade
Field is required!
Field is required!