Hebrew School Student Profile 2024-2025

First Name:

Last Name:

Email:

CONFIDENTIAL STUDENT PROFILE ‐‐ SCHOOL YEAR 2024-2025
*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:

Child's Name 1:

Date of Birth:

Grade:

Please share with us how your child learns best:

Does your child have an IEP?

Does your child have a 504 plan?

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?

NoYes

If other, please elaborate:

Has your child ever received professional counseling?

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?

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?

Does your child have a 504 plan?

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?

If other, please elaborate:

Has your child ever received professional counseling?

If YES, please answer the following questions:

1. How long has your child received counseling?
2. For what purpose was your child receiving counseling?

Contact Information of Psychologist/Psychiatrist/Counselor:

Please include Contact Name, Phone and Email.

Additional Information:

Child's Name 3:

Date of Birth:

Grade:

Please share with us how your child learns best:

Does your child have an IEP?

Does your child have a 504 plan?

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?

If other, please elaborate:

Has your child ever received professional counseling?

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?

Contact Information of Psychologist/Psychiatrist/Counselor:

Please include Contact Name, Phone and Email.

Additional Information:

Child's Name 4:

Date of Birth:

Grade:

Please share with us how your child learns best:

Does your child have an IEP?

Does your child have a 504 plan?

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?

If other, please elaborate:

Has your child ever received professional counseling?

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?

Contact Information of Psychologist/Psychiatrist/Counselor:

Please include Contact Name, Phone and Email.

Additional Information:

CSAIR :: 475 West 250th Street :: Bronx, NY 10471 :: 718-543-8400 :: info@csair.org