Student Intake Survey

High Bluff Academy

Student Intake Survey

Please fill out the following questionnaire and click the submit button. All information will be kept strictly confidential and will only be shared with the staff members working directly with your child.

Student intake survey:

Student name:

School and grade

Please list the specific course(s) your child needs help with and include the current grade in each class.

Please identify the specific areas of concern that you have about your child: (Hold the control key to select more than one option)

Please describe any learning disabilities or elaborate on your educational concerns for your child:

Briefly describe your child's experience with this academic subject in the past. Is this a relatively new problem?

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High Bluff Academy Phone: (858) 509-9101

12520 High Bluff Dr. Suite 140 Fax: (858) 630-3606

San Diego, CA 92130 info@highbluffacademy.com