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Survey

Pupil Information

Please fill out pupil information.

Student Name
Date
School
Does your child speak any language other than English?: yes; no
If yes, what was the first language your child learned to speak?
What language does your child speak most often?
Is your child a Migrant student?: yes; no
Is your child a homeless student?: yes; no
Is your child a neglected and/or delinquent student?: yes; no
Does your child have any disability (SPED) needs?: yes; no
If yes, please explain.
Does your child need speech services?: yes; no
Is your child in the gifted program?: yes; no
Parents Name

618 Summit Street
Winona, MS 38967

(662) 283-4533

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