Family Well-Being Survey

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Berea City School District staff is busy planning for the 2020-2021 school year. Please complete the form below to help Berea City School District provide social emotional support and resources to students and families during the COVID-19 pandemic and return to school. If you answer that you need help or support, a district staff member will reach out to you.

First Name *

Last Name *

Which school(s) does your child(ren) attend? Check all that apply *

Berea-Midpark High School

Berea-Midpark Middle School

Big Creek Elementary School

Brook Park Elementary School

Grindstone Elementary School

J&G Snow School

Required

Has anyone in your family experienced a loss or significant medical crisis due to COVID-19? *

Yes

Prefer not answer

Are your family’s basic needs being met (food, shelter, clothing,etc.)?

Yes

Prefer not to answer

Clear selection

If you answered no to the above question about basic needs, please explain.

What level of support does your family need right now to ease your stress?

We are well. We have all the support we need.

We are okay. We can manage this for now.

We are not doing so well. We could use some help.

We are having a hard time. We need to talk to someone.

Clear selection

What supports/resources would be helpful at this time?

Social Emotional information (anxiety, stress management, depression)

Parent/Caregiver workshops

Community Resources Guides/Activities

Connecting to community resources (therapist, food, housing,etc)

Other:

Clear selection

Do you need help connecting to community resources?

Yes

Maybe

Clear selection

What, if any, additional support do you think your child will need as we begin remote learning in September?

Anything else you would like to share at this time?

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Berea City School District. Report Abuse

Forms