Occupational Survey- SCMS (English)

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Please complete this form for EACH Sumter County Middle School student you have in your household.

Email Address

Today's Date *

YYYY

Has anyone in your household moved in order to work in another city, county, or state, in the last three (3) years? *

Yes

Has anyone in your household been involved in one of the following occupations, either full or part-time or temporarily during the last three (3) years? *

Yes

If you answer “yes”, check all that applies: *

1) Planting/Picking vegetables (tomatoes, squash, onions, etc.) or fruits (grapes, strawberries, blueberries, etc.)

2) Planting, growing, cutting, processing trees (pulpwood), or raking pine straw

3) Processing/Packing agricultural products

4) Dairy/Poultry/Livestock

5) Packing/Processing meats (beef, poultry, or seafood)

6) Commercial fishing or fish farms

N/A

Other:

Required

Names of Parent(s) or Legal Guardian(s) *

Current Address *

City *

State *

Zip Code *

Phone *

On the next screen, you will enter the names of the children in your household.

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