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2022-23 JCS FRYSC Elementary Youth Survey
Dear Students,
Please complete this survey to help us decide what programs/activities will be offered here at Jackson City School. Your answers will remain anonymous (secret) so please be honest. Thank you!
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* Indicates required question
Grade
*
2nd
3rd
4th
5th
Basic Needs: Do you need help with or worry about: Check all that apply.
*
Having food at home
Having the supplies you need for school
Becoming homeless
Having clothes to wear that fit
Having supplies needed to stay healthy (toothpaste/brush, soap, shampoo, etc.)
None
Required
Health: Do you need help with or worry about: Check all that apply.
*
Dental Care
Vision/Hearing Care
Information on healthy eating/activities
Stress Management
Dealing with divorce
Abuse at home
Grief - Dealing with the death of a family member or friend
Anger Management
Parent/family member in jail
Getting along with friends
Bullying problems
Self-esteem (Feeling good about yourself)
Violence in school
Fitting in
Getting along with teachers
Planning for the future (what you want to be when you grow up)
None
Required
I feel pressured to experiment with drugs/tobacco alcohol by relatives and/or friends:
*
Never
Regularly
Sometimes
I use tobacco products.
*
Never
Sometimes
Regularly
I use alcohol products.
*
Never
Sometimes
Regularly
I use marijuana or other drugs
*
Never
Sometimes
Regularly
What are your academic needs? Check all that apply.
*
Tutoring
Homework Help
Attendance
Information on Careers
School supplies
None
Required
What top three social/emotional concern do kids your age have? (anger, bullying, stress, etc.)
*
Your answer
What are some activities that interest you? (art, clubs, drama, music, etc.)
*
Your answer
When would you like to do these activities?
*
Before School
After School
Summer
Weekends
Required
Can your family bring you to activities when school is out?
*
Yes
No
Sometimes
Do you ride the school bus?
*
Morning and After School
Morning only
After School only
Sometimes when my parents need me to
Never
If you need more information on anything mentioned in this survey, please let your teacher know and Mrs. Ashley Combs will be happy to help you.
Your answer
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