Intake Form | 2e4me

Intake Questionnaire

Thank you for your interest in 2e4Me! In order to see if our Academy is right for your child, please complete this online in-take form.

Parent/Gaurdian First Name

Parent/Gaurdian Last Name

Parent/Gaurdian Phone

Parent/Gaurdian Email

Address

Child's Age or Date of Birth

Current Grade Level (if applicable)

If so for how long?

Does the child do best in large classrooms, in small groups or in a 1-1 setting?

How would you describe the child's strength?

Are there specific lagging skills or areas of need which might require (or benefit from) more focused support?

What are the child's interests, passions or potential areas of talent or academic affinities? If the child were allowed autonomy for a few hours without intervention from parents/adults at home, would the child most likely engage in any of these listed interests or activities? If not, what would the child do instead?

What are the child's dislikes?

Please describe any specific sensitivities or potential distressing triggers, any strategies which have already been implemented to successfully prevent these, and any soothing/coping strategies which have been helpful after the occurrence of a trigger.

Describe the ideal school environment, teachers, schedule and peers for your child

Any other information you'd like to share?

Thank you for your interest!

Intake Questionnaire

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