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Family Needs Survey (English)
This survey is OPTIONAL. Please fill this out if you would like our school social worker or family advocate to reach out to you with information regarding community resources that might be able to assist your family.
If you have any questions, please contact our school social worker:
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* Indicates required question
Parent/Guardian Name(s):
*
Your answer
Phone Number(s):
*
Your answer
Student Name(s):
*
Your answer
When is the best time for us to call and speak with you? (Check all that apply)
*
Morning (8:00 AM - 12:00 PM)
Afternoon (12:00 PM - 4:30 PM)
Required
Please indicate which resources your family needs assistance with at this time:
No
Yes
Clothing
Housing
Utilities (Gas, electricity, heat, etc..)
Employment
Food
Transportation to/from school
School supplies
Free/Reduced lunch application
Medical/Dental/Vision
Accessing mental health counseling
Internet/Wifi at home
Access to a computer at home
Thanksgiving meal assistance
Christmas assistance
No
Yes
Clothing
Housing
Utilities (Gas, electricity, heat, etc..)
Employment
Food
Transportation to/from school
School supplies
Free/Reduced lunch application
Medical/Dental/Vision
Accessing mental health counseling
Internet/Wifi at home
Access to a computer at home
Thanksgiving meal assistance
Christmas assistance
Clear selection
If you answered "yes" to any of the resources above, please tell us more about what your family needs:
Your answer
Is there any other information you would like us to be aware of?
Your answer
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