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Hello Breakthrough Families! Please fill out this survey to help us determine how we can best support you in the coming weeks. Your responses will help us connect you with the right resources and share the most relevant information. The survey has 23 very short questions and will take approximately 4 minutes to complete. Please reach out to us if you have any questions.  

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* 1. Parent/Guardian Name

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* 2. Student Name

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* 3. Student Current Grade

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* 4. Student Current School

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* 5. Breakthrough Campus

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* 6. Do you live with someone who is considered most vulnerable for COVID-19? This includes adults over the age of 60 or anyone who is immunocompromised (people with a reduced ability to fight infections or disease).

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* 7. Has anyone in your household been diagnosed with COVID-19?

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* 8. Does anyone in your household have symptoms of COVID-19 (fever, cough, or trouble breathing)?

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* 9. Do you know how to get medical support if needed?

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* 10. Are you concerned about having enough food and/or cleaning supplies at home?

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* 11. Are you aware of the food distribution centers in your city?

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* 12. Are you experiencing or do you expect a loss of income during the shelter in place and social distancing time period?

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* 13. Are you aware of any emergency grant programs in your city?

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* 14. Do you have reliable internet access at home?

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* 15. Are you aware of free internet options? 

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* 16. Do you have a working computer at home (not including one provided by your child's school)?

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* 17. Did you receive a chrome book from your child's school?

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* 18. Do you still need a computer? 

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* 19. Have you received schoolwork from your child's teachers?

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* 20. If yes, did you receive a packet or online assignments?

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* 21. For families with a current Breakthrough senior, do you need support with asking the college you plan to go to for a deposit extension?

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* 22. Have you been receiving Breakthrough's weekly email updates?

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* 23. If you have not been receiving Breakthrough's weekly email updates, please share your email address below.

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* 24. Is there anything Breakthrough can do to support you during this time?

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