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MLCHS Parent Survey 2019-2020 (Anonymous)
The Youth Services Center at Collins High School is seeking your feedback. We will use your anonymous responses to develop better programs and services that help student overcome barriers to success. Thank you for participating.
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* Indicates required question
Please check the grade level of your CHS child or children. Check all that apply.
*
9th
10th
11th
12th
Required
Tell us about your MLCHS student(s): Check all that apply
*
My child lives with a parent or step-parent
My child lives with a grandparent or guardian
My child lives in a single parent home (divorced/separated, etc)
My child has medical coverage
My child has dental coverage
My child recieves regular vision screenings when needed
My child is involved in extra-curricular or academic programs at the school
My child is employed
Required
What issues has your family faced in the past 12 months? Check all that apply.
*
Loss of employment/lack of employment opportunities
Unmet medical or dental health issues
Arrested or incarceration of a household member
Lack of health insurance
Lack of reliable transportation
Behavior issues with your student
Verbal/Physical/Emotional abuse in the home
Household member with drug or alcohol use
None
Required
Please check any health issue(s) that you feel prevent your student from learning. Check all that apply.
*
Asthma
Dental Issues
Diabetes
Hearing or Vision loss
Obesity
Substance Use
Mental/Emotional Health Issues
Other
None
Required
What can we do to help? Please check the services or programs that you and/or your child would attend. Check all that apply.
*
Parent Workshops (i.e: Budgeting, Healthy Living, etc)
Summer Programs for students (i.e: Resume/Interview class, Cooking Class, College Tours)
After School Activities (i.e: Family Nights, Drug prevention presentations, Alive at 25 class, etc)
Required
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