Family Resource Center Parent/Guardian Survey 2023-2024

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* 2. Who does your child(ren) live with?

Both Parents (Same Household)

Both Parents (Living Apart)

Mother Only

Father Only

Grandparent(s)

Other Relative/Guardian

Foster Care

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* 3. What are your children’s ages? (Check all that apply)

0-2 years old

3-4 years old

5 (but not yet enrolled in school)

Elementary

Middle

High

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* 4. If you need assistance getting childcare, please indicate what time(s) of day.

Before School

Full Day

After School

Evening

Summer

Not Applicable

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* 5. Does your child have a parent/guardian who is currently on Active Duty Military or in the Reserves?

Yes

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* 6. Does your child have a parent/guardian currently in jail?

Yes

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* 7. Do you have a need for more after-school programs?

Yes

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* 8. Do you have a need for more summer enrichment programs?

Yes

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* 9. Please indicate the most common reason(s) your child(ren) are absent from or tardy to school. (Check in the box for all that apply.)

Health

Transportation

Oversleeping

Family Emergency Issue

Babysitting Younger Sibling

Not Applicable

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* 10. Do you feel confident in helping your child with their school work?

Yes

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* 11. Are all children in your household covered by medical insurance?

Yes

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* 12. Are all adults in your household covered by medical insurance?

Yes

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* 13. Are all children in your household covered by dental insurance?

Yes

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* 14. Are all adults in your household covered by dental insurance?

Yes

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* 15. If you are pregnant or a new parent (0-2 years) do you need resources for you or your baby?

Yes

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* 16. What is your primary source of transportation?

Personal Vehicle

Bus

Walk

Friends/Family

Other (please specify)

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* 17. What is your education level?

No High School

Some High School

High School Diploma/GED

Some College/Vocational/Tech

College Graduate

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* 18. Is there someone in your household who needs employment assistance?

Yes

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* 19. Are any adults in your family seeking employment?

Yes

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* 20. The following is a list of common Health concerns that may interfere with a child's learning. Please select any concern(s) that you feel is currently interfering with your child's learning.

Lack of Food

Homelessness/Eviction

Immunizations/Physicals not Current

Untreated Medical Problems

Untreated Hearing Problems

Untreated Dental Problems

Untreated Vision Problems

Disconnected Utilities

Hygiene Issues

ADHD/ADD

Headaches/Migraines

Inconsistent Medication

Chronic Pain/Hurting

Lack of Sleep

Stomach Issues

Lice

Flu/Viruses/Colds

Allergy/Asthma

Bathroom Issues

Diabetes/Obesity

Upper Respiratory Issues

Other (please specify)

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* 21. The following is a list of common Social/Emotional concerns that may interfere with a child's learning. Please select any concern(s) that you feel is currently interfering with your child's learning.

Lack of Clothing/School Uniforms

Lack of School Supplies

Attendance/Truancy/Tardies

Anxiety/Stress

Bullying

Depression

Grief

Abandonment

Divorce

Bed Wetting

Learning Difficulties/Disorder

Tutoring/Homework Help

Lack of Self-Esteem

Cutting/Self-Harm

Eating Disorder/Self-Image

Drug/Alcohol Abuse

Physical/Sexual Abuse

Verbal/Emotional Abuse

Family/Domestic Abuse

Suicidal Thoughts/Attempts

Anger Management

Peer Relationships

Social Media

Out of Control Behavior

Other (please specify)

Important: If you are in need of help or services right now, please call or stop by the Family Resource Center.

Family Resource Center Parent/Guardian Survey 2023-2024

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* 1. School Name

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* 2. Who does your child(ren) live with?

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* 3. What are your children’s ages? (Check all that apply)

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* 4. If you need assistance getting childcare, please indicate what time(s) of day.

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* 5. Does your child have a parent/guardian who is currently on Active Duty Military or in the Reserves?

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* 6. Does your child have a parent/guardian currently in jail?

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* 7. Do you have a need for more after-school programs?

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* 8. Do you have a need for more summer enrichment programs?

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* 9. Please indicate the most common reason(s) your child(ren) are absent from or tardy to school. (Check in the box for all that apply.)

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* 10. Do you feel confident in helping your child with their school work?

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* 11. Are all children in your household covered by medical insurance?

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* 12. Are all adults in your household covered by medical insurance?

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* 13. Are all children in your household covered by dental insurance?

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* 14. Are all adults in your household covered by dental insurance?

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* 15. If you are pregnant or a new parent (0-2 years) do you need resources for you or your baby?

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* 16. What is your primary source of transportation?

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* 17. What is your education level?

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* 18. Is there someone in your household who needs employment assistance?

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* 19. Are any adults in your family seeking employment?

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* 20. The following is a list of common Health concerns that may interfere with a child's learning. Please select any concern(s) that you feel is currently interfering with your child's learning.

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* 21. The following is a list of common Social/Emotional concerns that may interfere with a child's learning. Please select any concern(s) that you feel is currently interfering with your child's learning.