RtI Parent/Guardian Concerns Questionnaire
1. What concerns do you have about your child's learning or school performance, or about your
child's attention, concentration, impulsivity, and/or activity?
2. What problems does your child have completing his/her homework?
3. What are some additional details about your child's difficulties?
4. Have there been any stressful events, either currently or at the onset of school problems?
5. What are your child’s strengths?
6. How does the child get along with peers? Which extracurricular activities is the student involved
in? How does he/she do?
7. Are there any documented medical concerns?
8. Is there a history of similar concerns in the family?