PARENT QUESTIONAIRE

Thanks for taking the time to answer these questions.  The answers will help
us learn more about how kids learn on MOOSE Crossing, and help us better work
with your child.  Your answers will be kept strictly confidential.


1.  What is your child's full name and age?




2.  What sort of school does your child attend?  (Public or private? 
    Any particular philosophy or emphasis?  ie. Montessori, Steiner, etc.)




3.  Is your child in a special-needs classroom?  If so, what kind?




4.  Does your child have particular difficulty with any subjects at school?
    Explain.




5.  Does your child have unusual ability in any subjects at school?




6.  Does your child have any other unusual abilities (outside of school)?





7.  How does your child relate to other children (shy, aggressive, etc.)?




8.  Is there anything else you would like to tell us about your child?





9.  What are the occupation(s) of the child's parent(s) or legal guardian(s)?




10.  What is the highest level of education attained by each of the child's
     parent(s) or legal guardian(s)?  (some high school, completed high school,
     college, graduate or professional degree, etc.)




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Please print out this and all other applicable forms, complete them, sign
them, and return them via regular mail to:

MOOSE Crossing Applications
c/o Amy Bruckman
 College of Computing
 801 Atlantic Ave
 Georgia Institute of Technology
 Atlanta, GA 30332-0280
 USA
 
 You can also fax them to 404-894-3146. Sorry, but we can not accept
 applications via email.
 
 More information is available at:
 http://www.cc.gatech.edu/elc/moose-crossing
 
 If you have any questions or problems, send email to:
 moose-request@cc.gatech.edu
 
 Thank you for your patience with these formalities! 
 
 -- Amy Bruckman
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