PBIS Family School Climate Survey

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Please answer all of the questions or your answers won’t be recorded, but you can mark “I prefer not to answer” if you don’t want to answer a question about you. The PBIS team at East will review the survey results and use it for future planning.

Demographics

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

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?

Female

Male

Non-binary, transgender or other

I prefer not to answer

Clear selection

What is your ethnicity?

Hispanic or Latino/a/e

Not Hispanic or Latino/a/e

I prefer not to answer

Clear selection

What is your race? (mark all that apply)

American Indian or Alaskan Native

Asian

Black or African America

Native Hawaiian or Pacific Islander

White

I prefer not to answer

Clear form

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