Chimacum School District Needs Survey
We understand how difficult this time is for our families and community.   This survey will help us learn about your needs
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Parent/Guardian First and Last Name *
Student Names (First and Last) *
Schools your child/children attend (check all that apply): *
Required
How many youth ages 0-18 are in your home? *
Parent Email *
Phone Number *
What method of communication do you prefer (check all that apply)? *
Required
If you would like your child (age 0-18) to access free meals, which site/option will you use? *
If you selected school bus delivery, what is your address so we can help you find the closest bus stop to your home?
Do you have Internet access from your home? *
Does your child have access to technology such as a laptop, desktop, or tablet? *
Would you like to check out a laptop from the District for your child to access resources? *
If you would like to check out a laptop, you assume full responsibility for the replacement cost of the laptop/tablet in the event the student or family loses possession of the laptop/tablet for any reason or in the event the laptop is destroyed or rendered useless due to damage while in the care of the student or family, including loss of use due to theft, fire, flood,lightning, or any other cause. *
Are there other resources your family needs support accessing?
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