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Family Needs Assessment
This assessment is to help meet the needs of all our Cook County School families during the Covid-19 Pandemic. This information is confidential and will be shared with the School Social Worker to help connect you with resources.
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Family Needs Assessment Questions
These questions are helpful for all families to complete as we know the Pandemic has affected families differently and do not want to assume families are all in the same situation.
Would you like our School Social Worker to contact you regarding Resources/Services to help you and your family with basic needs and/or mental health services?
Yes
No
Other:
Clear selection
Are you concerned with your ability to have food for your family?
Yes
No
Sometimes
Clear selection
Do you have a stable home to live in?
Yes
I have temporary housing and am worried about being displaced.
No
Other:
Do you have health insurance?
Yes
No
No but I would like information.
Clear selection
Do you have reliable internet?
Yes
No
We have internet, but it is isn't always reliable.
Clear selection
Do you worry about heating your home this winter?
Yes
No
Clear selection
Due to access and/or financial hardship, what winter items do you need help getting for your family?
Hats
Mittens
Jacket
Snowpants
Boots
Other:
Please list items and sizes needed and we will see if we can help meet the needs of your family.
Your answer
Do you have access to transportation?
Yes
No
No and I would like more information about local services.
Clear selection
Overall, how would you say you and your families Mental Health is?
We are doing okay.
We are struggling.
We would like information on services that could help our Mental Health.
I prefer not to answer.
Clear selection
What other needs do you have that we have not already covered?
Your answer
Given that we are in a Pandemic, if you were to reflect on the first half of the school year, how would you rate your overall satisfaction with the school year so far?
Very Satisfied
Satisfied
Neutral
Dissatisfied
Very Dissatisfied
Other:
Clear selection
Is there anything else you would like to share?
Your answer
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