• Communication Questionnaire  


    Student Name: _________________________________________________ 

    Student Birthday: _______________________________________________ 

    Parent/Guardian Name(s): _________________________________________ 

    What is the best way for me to contact you?   

                  ____ Phone   ____ Email  

    Phone Number: _________________________________________________ 

    Email Address: _________________________________________________ 

    What are your child’s interests/hobbies? 


    Is there anything you would like me to know about your child?



    This questionnaire is to help me get to know your child a little better.  The information provided will be kept confidential. Parent-teacher communication is important to me, and I believe it will be beneficial to your child as well.  Thank you for your support! 



    Jeanne Bartley, M.A., CCC-SLP
    Speech-Langauge Pathologist
    (908) 284-7650