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Social Investigation Child Questionnaire

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Submitted on Aug 30, 2026 at 3:48 PM

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Social Investigation Child Questionnaire

Instructions
This questionnaire is part of a court-related Social Investigation. Complete it personally, thoroughly, and truthfully. Do not allow another person to answer on your behalf. Attach additional pages when necessary and clearly label each attachment by section number.

Because a separate Parent History Questionnaire will be completed, this form focuses specifically on the child’s experiences, development, emotional and behavioral functioning, family relationships, safety concerns, adjustment, and needs. It’s also including limited questions regarding child’s exposure to family conflict, parenting arrangements, and issues relevant to the Social Investigation.

Complete one form for each child involved in this social investigation.

I understand and agree:

I have answered these questions truthfully and to the best of my ability.^*

I will supplement my answers if I later learn information is incomplete or inaccurate.^*

I understand that false, incomplete, or misleading answers may be considered by the evaluator and the Court.^*

I understand the evaluator may compare my answers with records, interviews, collateral information, and other evidence.^*

Email^*

SECTION 1 - CHILD INFORMATION

Child Full Name^*

Date of Birth^*

Current Age^*

Current Grade^*

Current School^*

Person Completing Questionnaire^*

Relationship to Child^*

Current Parenting Schedule^*

SECTION 2 - CHILD OVERVIEW AND FUNCTIONING

Rate Emotional Functioning (Excellent/Good/Fair/Poor) and Explain^*

Rate Behavioral Functioning (Excellent/Good/Fair/Poor) and Explain^*

Rate Academic Functioning (Excellent/Good/Fair/Poor) and Explain^*

Rate Social Functioning (Excellent/Good/Fair/Poor) and Explain^*

Rate Adaptability to Change (Excellent/Good/Fair/Poor) and Explain^*

Describe this child's greatest strengths^*

Describe this child's greatest challenges^*

Describe three things that make this child unique^*

SECTION 3 - FAMILY RELATIONSHIPS MATRIX

Relationship with Mother^*

Relationship with Father^*

Relationship with Siblings^*

Relationship with Stepparents/Partners^*

Relationship with Grandparents^*

Relationship with Extended Family^*

Identify the three adults this child is closest to^*

SECTION 4 - SCHOOL FUNCTIONING

School history and attendance^*

Academic performance^*

Behavioral concerns^*

IEP/504/Gifted services^*

Tutoring or academic supports^*

Educational strengths and weaknesses^*

SECTION 5 - MEDICAL AND MENTAL HEALTH HISTORY

Primary physician^*

Medical diagnoses^*

Mental health diagnoses^*

Current medications^*

Hospitalizations^*

Surgeries^*

Head injuries^*

Current providers^*

Counseling history^*

Psychological evaluations^*

Psychiatric treatment history^*

SECTION 6 - DEVELOPMENTAL HISTORY

Pregnancy complications^*

Birth complications^*

Prematurity/NICU stay^*

Speech delays^*

Language delays^*

Learning disabilities^*

ADHD concerns^*

Autism concerns^*

Other developmental concerns^*

SECTION 7 - CHILD ADJUSTMENT TO SEPARATION

Initial response to separation/divorce^*

Current adjustment^*

Changes in mood, behavior, sleep, appetite, school performance, friendships, and activities^*

SECTION 8 - CHILD EXPOSURE TO CONFLICT

If yes to any of the above, please explain:^*

SECTION 9 - CHILD EXPOSURE TO ADULT ISSUES

If you checked any of the above, please explain. Include who was involved, approximately when it occurred, and how you became aware of the child's exposure.^*

SECTION 10 - CHILD STATEMENTS, PREFERENCES, AND CONCERNS

Positive comments child has made about Mother^*

Positive comments child has made about Father^*

Concerns child has expressed regarding Mother^*

Concerns child has expressed regarding Father^*

Concerns child has expressed about the family situation^*

Provide examples and context^*

SECTION 11 - BEHAVIORAL AND SAFETY CONCERNS

School discipline^*

Suspensions/expulsions^*

Running away^*

Self-harm concerns^*

Threats to others^*

Property destruction^*

Substance use^*

Law enforcement involvement^*

DCF involvement^*

SECTION 12 – CHILD STRENGTHS AND PROTECTIVE FACTORS

Who does the child turn to for support?^*

Activities that build confidence^*

Protective adults in the child's life^*

Strengths that help the child cope with stress^*

Community, school, religious, or extracurricular supports^*

SECTION 13 - CHILD'S FUTURE NEEDS

What does this child need most right now?^*

What services would benefit this child?^*

What parenting arrangement would best support this child's needs?^*

SECTION 14 - CHILD TIMELINE

Parents separated^*

School changes^*

Counseling started^*

Medical diagnoses^*

DCF investigations^*

Major relocations^*

Significant losses or life events^*

SECTION 15 - DOCUMENT PRODUCTION CHECKLIST

Educational Records^*

Check any documents you are providing or believe are relevant to this child.

Report cards

Attendance records

Discipline records

IEP/504 Plans

Gifted Program Documentation

Standardized Testing Results

School Emails/Communications

Tutoring Records

Other Educational Records

Agency and Safety Records^*

DCF/CPS Records

Law Enforcement Reports

Child Advocacy Center (CAC) Records

Court-Appointed Professional Reports

Other Agency Records

Extracurricular and Community Records^*

Extracurricular Activity Records

Awards/Certificates

Sports Records

Club or Organization Records

Summer Camp Records

Religious Education Records

Other Community Records

Digital and Communication Records^*

Emails

Text Messages

OurFamilyWizard Records

TalkingParents Records

Social Media Posts

Photographs

Videos

Audio Recordings

Other Digital Records

SECTION 16 - ADDITIONAL INFORMATION

What else should the evaluator know about this child?^*

SECTION 17 - CHILD ELECTRONIC DEVICE QUESTIONS

Does the child have a phone?^*

Does the child have a tablet?^*

Does the child have a smart watch?^*

Does the child have social media accounts?^*

Who pays for the device?^*

Who controls the device?^*

Are parental controls used?^*

Is communication with the other parent monitored?^*

SECTION 18 - CHILD'S FAVORITE THINGS

Favorite activities^*

Favorite games^*

Favorite YouTube channels^*

Favorite subjects^*

Best friend^*

Future career interests^*

VERIFICATION AND CERTIFICATION

Printed Name^*

Signature^*

Sign here

Date^*

Page Initials Confirmed^*

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