Family PBIS School Climate Survey

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Please answer all of the questions. You can mark "I prefer not to answer" if you don't want to answer a question about you.

Demographics

Section 1 of 6

Please indicate the grade of your student or students. (mark all that apply)

Kindergarten

1st Grade

2nd Grade

3rd Grade

4th Grade

5th Grade

6th Grade

7th Grade

8th Grade

9th Grade

10th Grade

11th Grade

12th Grade

I prefer not to answer

Is your student enrolled in any of these programs? (mark all that apply)

Special Education Program or has an Individualized Education Program (IEP)

Gifted Program or Honors/Advanced Placement Courses

Not applicable, not sure, I prefer not to answer

What is your gender identity?

Female

Male

Non-binary, transgender or other

I prefer not to answer

Clear selection

What is your ethnicity?

Hispanic or Latino/a

Not Hispanic or Latino/a

I prefer not to answer

Clear selection

What is your race? (mark all that apply)

American Indian or Alaskan Native

Asian

Black or African American

Native Hawaiian or Pacific Islander

White

I prefer not to answer

Beyond that, is there another ethnic group with which you identify? (if you prefer not to answer, then write " I prefer not to answer")

Clear form

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