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Particulars of Legal Guardian (if child is not in parents’ care)

Please attach a photocopy of Certificate of Legal Guardianship.

Name		NRIC / FIN / Passport No.
Date of birth (dd/mm/yyyy)		Marital status	r Single r Married r Separated r Divorced r Widowed
Country of birth		Race
Citizenship		Religion
Highest academic qualification	r No formal education r Primary r Secondary r Postsecondary (A levels, Diploma, ITE) r Graduate / Postgraduate	Gross monthly income	r No income r $2500 and below r Above $2500
Occupation		Spoken language(s)
Contact no. (Home)		Contact no. (HP)
Email		Relationship to Child
Residential address (if different from child’s residential address)

Particulars of Siblings & Any Other Relatives Staying with the Child

Name	Relationship to Child	Date of birth / Age	Occupation	Monthly income (if applicable)

D. Parent Report

This section is for parents to provide information about their child. Referring agencies should assist parents in completing this section if necessary. The information will help the SPED school better understand the child’s strengths and needs and how to keep the child safe.

1.     What are your child’s strengths and interests?

2.     What is your child’s behaviour like on a typical day?

3.     What are some situations that may cause your child to be upset or distressed (e.g. changes to routines, unable to get what he or she wants, going to new places)? How often do they occur (e.g. once a day, 3 – 4 times a week)?

4.     What does your child do when he/she is upset or distressed? What are some of your child’s behaviors that may involve health and safety risks for your child or others (e.g. tendency to run away from school or house if unsupervised, injures self or others)?

5.     What do you do to help your child to calm down when he/she is upset or distressed?

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Author & Editor

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