DOÑA ANA COUNTY HEAD START
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- Monica Margarita Araya Cabrera
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1 DOÑA ANA COUNTY HEAD START STUDENT PROFILE Child s Name: Center: PERSONAL/SOCIAL DEVELOPMENT 1. What makes your child happy, and how does he or she express it? 2. What makes your child sad, and how does he or she express it? 3. How does your child behave when he or she is not feeling well? 4. What are your child s favorite things to do? 5. What frightens your child? 6. How does your child express him/herself? 7. Does your child play with other children? Yes 8. Does your child share his/her toys with others? Yes 9. Where does your child like to play? 10. What does your child do when he/she becomes angry? 11. Does your child have temper tantrums? Yes How is it displayed?
2 12. How does your child defend him/herself? Hit, kick, bite? Uses words? (Stop or ) Cries Tattles 13. Does your child possess any of the following self-help skills: Dresses themselves Feed themselves Toilet skills Other What does your child need assistance with? 14. What is your child s feeling about starting Head Start? 15. How does your child react to new people and situations? 16. How do you guide/discipline your child? FAMILY CULTURES Doña Ana County Head Start recognizes and honors each child s and family s cultural identity. Answering the following questions will help classroom staff affirm and foster children s knowledge and pride in their individual and family identity and foster children s knowledge, enjoyment, and respect of others. 17. What is your family s cultural/ethnic heritage? Black Anglo Hispanic Native American Other (Please Specify) 18. What family customs, special events or celebrations does your family observe? 19. What special stories, music, books, legends or folk stories does your child love to hear? 20. Does your family have special beliefs that would require an adjustment in your child s program of activities?
3 BEHAVIORAL HEALTH 21. Please check box if your child has experienced: Death of a family member or friend Parent incarcerated Death of a pet Witnessed violence Child removed from home (CYFD) New baby in family *Parents divorced or separated (*If checked please answer 22a-c) Serious illness (child) or illness of a family member Other (please explain) Date/s experienced any of the above: 22a. *If divorced or separated are both parents in contact with child? Yes 22b. *Is other parent interested in having home visits/conferences? Yes 22c. **Volunteering? Yes 23. Please indicate any significant changes in the following areas: Appetite Sleep Patterns Mood ne Other (please explain) 24. Has your child ever attempted to hurt him/herself or others? Yes (please explain) 25. Has your child ever received counseling? Check all that apply: Amanecer Yes Southwest Family Guidance Center Where? Family & Youth Inc. When? Southern NM Human Dev. Southwest Counseling Center La Casa 26. Other comments or concerns regarding child s behavioral health? **If yes, fill out Parent Involvement Opportunities form THANK YOU... and W E L C O M E to HEAD START This information will remain confidential. OR FOR TEACHER USE ONLY I verify that I have reviewed this form and have taken any needed actions regarding this child (e.g. value and respect child s personal/social/emotional development, cultural diversity and behavioral health. Teacher s Signature Date stpro/ss/3.96 Revised / Reviewed 6.15
4 HEAD START DEL CONDADO DE DOÑA ANA PERFIL DE NIÑO mbre del Niño: Centro: DESARROLLO PERSONAL/SOCIAL 1. Qué le causa a su niño alegría y como lo expresa? 2. Qué le causa tristes a su niño y como se expresa? 3. Cómo se comporta su niño/a cuando no se siente bien? 4. Qué son las cosas favoritas que hace su niño/niña? 5. Qué le provoca a su niño miedo? 6. Como se expresa su niño/niña? 7. Juega con otros niños? Sí 8. Sabe su niño/niña compartir con otros? Sí 9. En dónde le gusta jugar a su niño? 10. Cómo reacciona su niño/niña cuando se enoja? 11. Tiene su niño berrinches (corajes) frecuentemente? Sí Como lo muestra?
5 12. Como se defiende el niño por si mismo? Como lo muestra? Pega, da patadas, muerde? Usa palabras? (como o Estate quieto ) Llora Chismea 13. Tiene su niño experiencia en lo siguiente? Se viste solo Come solo Usa el escusado solo Otro En que necesita su niño/niña asistencia? 14. Cómo se siente su niño al saber que va a empezar Head Start? 15. Cómo reacciona su niño a nuevas personas y situaciones? 16. Qué método de disciplina emplea usted con su niño? CULTURA FAMILIAR El Head Start del Condado de Doña Ana reconoce y honora la identidad de cultura de cada niño y familia. Al dar una respuesta a las siguientes preguntas, ayudará al personal de la clase a afirmar el conocimiento y el orgullo de los niños de su identidad individual y familiar y aumentará el conocimiento, el placer, y el respeto hacia otras personas del niño. 17. Cual que la culturas forman a su familia? Negro Anglosajón Hispano Americano Indígena Otro (por favor especifique) 18. Qué eventos personales, celebraciones, y ocasiones celebra su familia? 19. Qué cuentos especiales, libros, música, leyendas y mitos le encanta oír a su niño? 20. Tienen sus familiar creencias especiales que requieren un ajuste en las actividades del programa de su niño?
6 ENCUESTA de SALUD MENTAL 21. Por favor marque si su hijo/hija a sufrido: Muerte de un miembro de la familia o amigo/a Muerte de un animalito domesticado *Divorcio o separación de los padres (*Si lo marco por favor responda a las preguntas 22a-c) Una enfermedad seria de un familiar niño/a Padre encarcelado Testigo de violencia Niño removida del hogar (CYFD) Una enfermedad en un miembro de la Otro (por favor explique): Fecha/s que experimento alguna de las de arriba: 21a. * Están divorciados o separados ambos padres que tienen contacto con el niño? í 22b. * Habrá otro padre interesado en tener las visitas a domicilio/conferencias? í 23c. ** Voluntario? **Sí es así, llene la forma de oportunidades para que se involucren los padres í 24. Por favor marque los cambios significantes en las áreas siguientes: Apetito Dormir Humor Ningunos Otro (por favor explique): 25. Ha atentado su niño dañarse a sí mismo o a otros? Sí (por favor explique): 26. Ha recibido su niño/niña consejería? Marque si se aplica: Amanecer Sí Cuando: Southwest Family Guidance Center Dónde: Family & Youth Inc. Southern NM Human Dev. Southwest Counseling Center La Casa 27. Comentarios, preocupaciones referentes a la salud mental de su niño/niña. G R A C I A S... Y B I E N V E N I D O S A HEADSTART Esta información se mantendrá confidencial. FOR TEACHER USE ONLY I verify that I have reviewed this form and have taken any needed actions regarding this child (e.g. value and respect child s personal/social/emotional development, cultural diversity and behavioral health. Teacher s Signature Date
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