Lyme School Family Assets and Needs Assessment
YOU MAY RESPOND ONLINE, ON PAPER, OR OVER THE PHONE. CALL 603-795-0603 TO COMPLETE THE SURVEY IN A FORMAT OTHER THAN THIS ONLINE FORM.

This form, designed with input from Lyme School families, is intended gain an understanding of the needs and concerns of families, as well as resources and offers to help, as the school year evolves. Questions ask for input about remote learning and other challenges that may arise.

Information is being captured by CommunityCare of Lyme (CCL). Individual responses will be kept confidential by CCL, unless permission is granted to share with others.

YOUR RESPONSE HELPS US HELP YOU, AS WELL AS OTHER SCHOOL FAMILIES!
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YOUR HOUSEHOLD
These questions ask about the number and grades of children and about work and other responsibilities of adults in your household.
In what grade(s) are the child(ren) in your household? (Please check all that apply.
How many children (birth through high school) are in your household?
How many students (all levels) are remote learning in your household?
Please click the option that best describes work or other primary responsibilities beyond your child(ren)'s education in your household. If none applies, please click "Other" and describe your situation.
HOW REMOTE LEARNING AFFECTS YOUR FAMILY
Most families (and our teachers and staff) find remote learning to be difficult. For the following questions, please check all that apply.
For our family, remote learning will be ...
Clear selection
If remote learning is TEMPORARY and short-term (less than one month) ...
If remote learning is full time for more than a month ...
Remote learning poses extraordinary challenges to families. We hope to understand what specific kinds of help you anticipate needing. Please check the appropriate column for each of the items listed. If a challenge for your family is not included, please describe it in the following question.
We WILL need help
We MIGHT need help
We WILL MANAGE
We have difficulty supporting the academic needs of our child(ren)
Our internet access is not sufficient to participate fully in remote learning
We don't have computers or tablets for everyone to do school and work
We don't have good space for everyone to learn and work at home
The family dynamics are very hard with my child(ren) learning at home
If our child(ren) are sent home or kept home on short notice, we don't have a consistent way to deal with it.
We need additional child care
We need additional care for adults in our household
Emotional support for my child(ren) is difficult
Emotional support for the adult(s) in our household is difficult
It is hard to get meals on the table with everything else going on
Transportation is a problem when someone in the household needs a ride during the day.
We can't get shopping or errands done regularly.
Household chores and repairs don't get done
Clear selection
Please describe extraordinary challenges your household faces during remote learning that are not captured above.
Do you know where to go to get help for needs you may have checked or described above? Please check "Other" to list needs for which you're not sure how to get help.
HOW YOU MIGHT HELP OTHERS
If you or someone else in your household could offer help or support to other families, please provide details below. (Consider the list above for ways you might contribute. Other ideas are welcome!)
How might you VOLUNTEER your help?
What PAID SERVICES might you offer?
ADDITIONAL QUESTIONS OR INPUT YOU MAY HAVE
Please share any other information, thoughts, or concerns regarding your family's remote learning and day care needs.
YOUR CONTACT INFORMATION
Name
Phone number
Please check the appropriate boxes about how this information may be shared. CommunityCare of Lyme will keep all information confidential, unless otherwise specified here.
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