Family Voice Survey  - DJUSD: Harper Jr High
To help us understand the local needs better, we are asking that you fill out the following survey.  The information you provide will help us develop additional programs and/or system improvements.  Although we want to know your thoughts on each question, you can skip any question you do not want to answer or do not know the answer to.
Sign in to Google to save your progress. Learn more
General Information:
1. Are you receiving the services and supports you need for you and the child or youth you care for?
Clear selection
2. If you answered “no” or “don’t know” to the question above, why? (check all that apply)
Service and Support Priorities:
1. What mental health services are you and/or your child/youth receiving now? (check all that apply)
2. Please identify up to three items from the following list that would be most helpful for the mental health of you and your family:
Outreach:
1. How do you find out about community resources and supports?  (check all that apply)
2. Which of the above is most helpful to you?
Tell us a little about yourself and the youth in your care.  If you prefer, you can skip this section and end the survey here.
1. What is your relationship to the children in your care? (check all that apply)
2. What are the ages of the child/children you care for? (Check all that apply)
3. What is the race of the child/children you care for? (check all that apply)
4. What is/are the gender of the child/children you care for? (check all that apply)
Clear selection
Additional Information:
1. What additional supports do you and the child or youth you care for need?  List by most important first.
2. Is there other information about yourself or family that you would like us to know?
Contact Information:
If you are interested in providing us with additional information, please provide your contact information below: (Name, Phone number, email address)
Thank you for participating in this survey.
Your voice and opinions matter!
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Yolo County Office of Education. Report Abuse