# Parent Summary Form

## Child’s Name: __________________________________________________________________

## Date: __________________________________________________________________________

## My child’s strengths:

## Focus areas:

**Activities:**

*Social-Emotional Assessment/Evaluation Measure (SEAM™), Research Edition by Jane Squires, Ph.D., Diane Bricker, Ph.D., Misti Waddell, M.S., Kristin Funk, M.A., LCSW, Jantina Clifford, Ph.D., & Robert Hoselton © 2014 Brookes Publishing. All rights reserved. SEAM™ and the SEAM logo are trademarks of Brookes Publishing.*  
www.brookespublishing.com/seam | 1-800-638-3775 |