Individual Child Profile

Child's Name*
First Last
Date of Birth*
Parent Name(s)*
First Last
Phone*
Email*
Gender*
- Male
- Female
Adopted?*
- Yes
- No
Age at Adoption
Blended Family?*
- Yes
- No
When?
Current Grade*

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General Attitude / Personality Traits
Reluctant Learner - Excitably Curious*
Please indicate on a scale of 1-5 this child's general attitudes and personality traits of Reluctant Learner to Excitably Curious. Short comments are also welcome (i.e. when around adults, when stressed, etc...).
Fearful - Daring*
Please indicate on a scale of 1-5 this child's general attitudes and personality traits of Fearful to Daring. Short comments are also welcome (i.e. when around adults, when stressed, etc...).
Compliant - Strong-Willed*
Please indicate on a scale of 1-5 this child's general attitudes and personality traits of Compliant to Strong-willed. Short comments are also welcome (i.e. when around adults, when stressed, etc...).
Ambitious - Lazy*
Please indicate on a scale of 1-5 this child's general attitudes and personality traits of Ambitious to Lazy. Short comments are also welcome (i.e. when around adults, when stressed, etc...).
Introverted - Extroverted*
Please indicate on a scale of 1-5 this child's general attitudes and personality traits of Introverted to Extroverted. Short comments are also welcome (i.e. when around adults, when stressed, etc...).
Shy - Friendly*
Please indicate on a scale of 1-5 this child's general attitudes and personality traits of Shy to Friendly. Short comments are also welcome (i.e. when around adults, when stressed, etc...).
Self-Reliant - Dependent*
Please indicate on a scale of 1-5 this child's general attitudes and personality traits of Self-Reliant to Dependent. Short comments are also welcome (i.e. when around adults, when stressed, etc...).
Unmotivated - Achiever*
Please indicate on a scale of 1-5 this child's general attitudes and personality traits of Reluctant Learner to Excitably Curious. Short comments are also welcome (i.e. when around adults, when stressed, etc...).
Slow Learner - Quick Study*
Please indicate on a scale of 1-5 this child's general attitudes and personality traits of Slow Learner to Quick Study. Short comments are also welcome (i.e. when around adults, when stressed, etc...).
Competitive - Non-Competitive*
Please indicate on a scale of 1-5 this child's general attitudes and personality traits of Competitive to Non-Competitive. Short comments are also welcome (i.e. when around adults, when stressed, etc...).
Sharp Memory - Forgetful*
Please indicate on a scale of 1-5 this child's general attitudes and personality traits of Sharp Memory to Forgetful. Short comments are also welcome (i.e. when around adults, when stressed, etc...).
Distractible - Attentive*
Please indicate on a scale of 1-5 this child's general attitudes and personality traits of Distractible to Attentive. Short comments are also welcome (i.e. when around adults, when stressed, etc...).
Disorganized - Goal-Focused*
Please indicate on a scale of 1-5 this child's general attitudes and personality traits of Disorganized to Goal-Focused. Short comments are also welcome (i.e. when around adults, when stressed, etc...).

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Tell us a little more about your child:
When my child has free time, he/she will...*
Please describe how your child interacts with others:*
Briefly describe your child

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School History
School history*
Under School type, please use the code PR=Private School, PS=Public School, H=Homeschool. Add in as many rows as applicable to your child. *Transcripts or Report Cards are required for all classes taken in or after 9th grade.
Grade Name of School Type Typical Grades Earned Problems? Praises? If homeschooling, what curriculum program was used?
Upload Transcript or Report Cards for high school students
Drop files here or

Accepted file types: jpg, gif, png, pdf, doc, Max. file size: 256 MB.

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Academic likes/dislikes
Bible
What books have you liked/disliked?
Phonics / Spelling
What books have you liked/disliked?
Reading / Literature
What books have you liked/disliked?
Grammar
What books have you liked/disliked?
Writing
What books have you liked/disliked?
Math
What books have you liked/disliked?
Science
What books have you liked/disliked?
History
What books have you liked/disliked?
Other
What books have you liked/disliked?

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Goals
Strengths
What do you see as your child's greatest strengths?
Needs
What do you see as your child's greatest needs?
Goals
What are your goals for your child this year?
Long Range Goals
What are your long range goals for your child?
Phone
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Individual Child Profile

Step 1 of 7

General Attitude / Personality Traits

Tell us a little more about your child:

School History

Medical History

Academic likes/dislikes

Goals

Product categories

Grade	Name of School	Type	Typical Grades Earned	Problems? Praises? If homeschooling, what curriculum program was used?