Sign In
Forgot Password
or Sign In With
Powered By
ShulCloud
Login
Facebook
Home
Happenings
Programming
Livestream at CSAIR
Calendar
YouTube Channel
About Us
Who We Are
Professional Staff
Leadership
Membership
History
General Information
Directions
Prayer
Synagogue Services
Livestream at CSAIR
Book of Remembrance
Holocaust Torah Scroll
Learning
Adult Programming
Program Guides
Hebrew School
Passport to Jewish Education
Teen Education
Online Cookbook
Israel
Israel Committee
Upcoming Programs
Past Programs
Community Programs
Nosim
Kan Archive
Resources
Get Involved
Men's Club
Sisterhood
Young Children's Family Program
Social Action
Riverdale Jewish Project
Intimate Voices
Safeguarding Our Children
Sisterhood Gift Shop
Past Events
Purim 2023
Gala 2023
Shabbat Across CSAIR
Community Art Project
Addressing-Racism
Payments/Donate
Contact Us
Facebook
Hebrew School Student Profile 2022-23
Please verify reCaptcha before submitting the form.
First Name:
Last Name:
Email:
CONFIDENTIAL STUDENT PROFILE ‐‐ SCHOOL YEAR 2022‐2023
*This form will be used for educational planning purposes only. Content will be viewed only by relevant educational staff and/or providers of direct or indirect educational services.
The CSAIR Marsha Dane Stern Hebrew School is committed to providing a quality Jewish education to every student, regardless of learning style or special learning needs. Please answer the questions below to help us create learning experiences that best fit the needs of each of our learners.
ACADEMIC BACKGROUND
Please fill out a form for each child attending the Marsha Dane Stern Hebrew School.
How many children do you have attending Hebrew School:
1 Child
2 Children
3 Children
4 Children
Child's Name 1:
Date of Birth:
Grade:
Please share with us how your child learns best:
Does your child have an IEP?
No
Yes
Does your child have a 504 plan?
No
Yes
If your child receives special accommodations through their IEP or 504 please list accommodations:
*Please provide a copy of the IEP and/or 504 plan.
RELATED SERVICES
Did your child receive any related services at school in the past academic year?
No
Yes
If yes, please share with us what related services were received:
Speech & Language
Occupational Therapy
Physical Therapy
Counseling
Resource Room
Pull Out
Collaborative Teaching
One on One Aide
Other
If other, please elaborate:
Has your child ever received professional counseling?
No
Yes
If YES, please answer the following questions:
1. How long has your child received counseling?
2. For what purpose was your child receiving counseling?
If yes, may we contact your child’s Psychologist/Psychiatrist/Counselor?
No
Yes
Contact Information of Psychologist/Psychiatrist/Counselor:
Please include Contact Name, Phone and Email.
Additional Information:
Please share any additional information or comments that may provide our staff with further insight into
your child’s personality and character and help us provide a successful experience for your child:
Child's Name 2:
Date of Birth:
Grade:
Please share with us how your child learns best:
Does your child have an IEP?
No
Yes
Does your child have a 504 plan?
No
Yes
If your child receives special accommodations through their IEP or 504 please list accommodations:
RELATED SERVICES
Did your child receive any related services at school in the past academic year?
No
Yes
If yes, please share with us what related services were received:
Speech & Language
Occupational Therapy
Physical Therapy
Counseling
Resource Room
Pull Out
Collaborative Teaching
One on One Aide
Other
If other, please elaborate:
Has your child ever received professional counseling?
No
Yes
If YES, please answer the following questions:
1. How long has your child received counseling?
2. For what purpose was your child receiving counseling?
No
Yes
Contact Information of Psychologist/Psychiatrist/Counselor:
Please include Contact Name, Phone and Email.
Additional Information:
Please share any additional information or comments that may provide our staff with further insight into
your child’s personality and character and help us provide a successful experience for your child:
Child's Name 3:
Date of Birth:
Grade:
Please share with us how your child learns best:
Does your child have an IEP?
No
Yes
Does your child have a 504 plan?
No
Yes
If your child receives special accommodations through their IEP or 504 please list accommodations:
*Please provide a copy of the IEP and/or 504 plan.
RELATED SERVICES
Did your child receive any related services at school in the past academic year?
No
Yes
If yes, please share with us what related services were received:
Speech & Language
Occupational Therapy
Physical Therapy
Counseling
Resource Room
Pull Out
Collaborative Teaching
One on One Aide
Other
If other, please elaborate:
Has your child ever received professional counseling?
No
Yes
If YES, please answer the following questions:
1. How long has your child received counseling?
2. For what purpose was your child receiving counseling?
If yes, may we contact your child’s Psychologist/Psychiatrist/Counselor?
No
Yes
Contact Information of Psychologist/Psychiatrist/Counselor:
Please include Contact Name, Phone and Email.
Additional Information:
Please share any additional information or comments that may provide our staff with further insight into
your child’s personality and character and help us provide a successful experience for your child:
Child's Name 4:
Date of Birth:
Grade:
Please share with us how your child learns best:
Does your child have an IEP?
No
Yes
Does your child have a 504 plan?
No
Yes
If your child receives special accommodations through their IEP or 504 please list accommodations:
*Please provide a copy of the IEP and/or 504 plan.
RELATED SERVICES
Did your child receive any related services at school in the past academic year?
No
Yes
If yes, please share with us what related services were received:
Speech & Language
Occupational Therapy
Physical Therapy
Counseling
Resource Room
Pull Out
Collaborative Teaching
One on One Aide
Other
If other, please elaborate:
Has your child ever received professional counseling?
No
Yes
If YES, please answer the following questions:
1. How long has your child received counseling?
2. For what purpose was your child receiving counseling?
If yes, may we contact your child’s Psychologist/Psychiatrist/Counselor?
No
Yes
Contact Information of Psychologist/Psychiatrist/Counselor:
Please include Contact Name, Phone and Email.
Additional Information:
Please share any additional information or comments that may provide our staff with further insight into
your child’s personality and character and help us provide a successful experience for your child:
Thu, June 1 2023 12 Sivan 5783
