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Instructions: To
be completed by parent or guardian
Name of Student:
_______________________________________ Date:
______________________
Directions:
Please answer each of the questions below in terms
of your child's homework and return the form to me.
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ITEM
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NEVER
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RARELY
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SOMETIMES
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OFTEN
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ALWAYS
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My child writes down
all of his or her homework assignments.
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My child brings the
homework planner or recorded assignments
home.
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My child brings home
the books or materials needed to complete the day's
homework assignments.
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My child knows and
understands the assignment(s).
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My child knows when
the assignments are due.
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My child starts
homework without reminding or nagging.
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My child completes
the homework without someone sitting with him or
her.
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If you have to help
your child with homework or supervise your child to
make sure the homework gets done, how much time are
you spending each day with your child on
homework?
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How much time does
student usually spend doing homework each
day?
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How often do you
fight with your child about homework?
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Use the back of this
page to let me know any concerns you have about
your child's ability to complete their homework. If
your child is on medication or has a condition that
affects his or her ability to do homework, please
let me know.
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