COUNSELING DEPARTMENT - Form for Parents

Please read carefully the requested information. This information is confidential and for the exclusive use of the Psychology Department. The clarity and honesty of your answers will help us know your child more thoroughly.

Contains questions about family information, birth and development, behavior / temperament, school history, daily habits / routine and discipline.

A a digital, passport type, picture of your child is required in order to complete this form.

If you have any questions, please do not hesitate to contact us to (809) 563-1707 or e-mail to admisiones@sms.edu.do.

The Counseling Department

11. General Data

22. Family Information

33. Birth/Development & 4. Conduct/Temperament

45. Education History

56. Work Habits/ Daily Routine & 7.Discipline

6Review Your Entry

2 x 2 Student Picture:

Agregar archivos

Passport picture type. File type allowed: jpg, jpeg, png, pdf
Complete name of student:
Date of Birth: Date of Birth: / DD / MM AAAA
Age:

Include years and months
Grade applying to:
Current Grade level:
School Year applying to:
First and last name of mother: First and last name of mother: Nombre Apellidos
Mother's Age:
Mother's Contact phone number: Mother's Contact phone number: - ### - ### ####
First and last name of father: First and last name of father: Nombre Apellidos
Father's Age:
Father's Contact phone number: Father's Contact phone number: - ### - ### ####
Name of Solicitor:
Solicitor's E-mail:

Contact E-mail address
Solicitor's Contact phone number: Solicitor's Contact phone number: - ### - ### ####
Today’s date: Today’s date: / DD / MM AAAA
1. GENERAL DATA:
Knows English?

Knows English? Yes No
Mother tongue:
Language spoken at home:
Person that takes care of child upon the absence of parents:
Age:

COUNSELING DEPARTMENT - Form for Parents

COUNSELING DEPARTMENT - Form for Parents

1. GENERAL DATA: