New Day, Inc. Parent Project Pre-Class Assessment
Name____________________________________
Date_____________________________________
DOB_____________________________________
Child(ren) name(s) Age Grade School
1____________________________________________________
2____________________________________________________
3____________________________________________________
4____________________________________________________
5____________________________________________________
6____________________________________________________
7____________________________________________________
8____________________________________________________
I am coming to Parent Project training because:
A) The court ordered my participation
B) The court suggested my participation
C) The police suggested my participation
D) The school required my participation
E) The school suggested my participation
F) A counselor /clergy (not school) suggested my participation
G) I want to learn how to do a better job before (more) trouble happen
Please circle the applicable response below:
What is your parenting situation? Solo spouse other adult resident "ex"
Church faith-based attendance? Never rarely sometimes regularly
Your education: completed grade 8, 9 ,10, 11, 12, GED, Tech school, some college, college grad
On the last semester report card issued for your child, what were his/her grades?
Eng_____ Math_____ Science_____ History_____ other_____
How many days was he/she absent during that semester?____
Excused from school?___
______home _____school _____elsewhere
The problems that need work on in this juvenile behavior are ( indicate all that apply):
___parents ___other adults ___younger siblings ___teachers ___older siblings ___ ___anger ___school attendance ___appropriate friends ___depressions Other _________________________________________________________
Other people with whom the juvenile has problems are (indicate all that apply):
other juveniles ___ friends
The problems (you think) the juvenile has are (number the three worst in order):
___grades ___dating ___eating disorder ___homework ___chores
___neatness ___drugs ___disruptive behavior ___following rules ___gangs/occult
___sex ___teasing others ___property damage ___running away alcohol
Review positive descriptors list below. Check all that apply to your child.
Remember that these provide you with hope concerning your child’s future.
__artistic __athletic __attractive __bright __caring __creative
__faith/spiritual grounding __friendly __healthy __helpful __interesting person
__loving __has memories of good times with family __musically talented
__supportive family __thoughtful __resilient "bounce back" personality
__supportive neighbors & or friends __sense of humor __nice smile
__positive role models in family, school, church, & or community
__positive "family values" family __supportive family
others____________________________________________________________
Other comments that you feel would be helpful for us to know while we are preparing for the upcoming Parent Project class...