Essential Worker Survey

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

This survey is collecting information to help us best serve scholars whose parents are essential workers. You are receiving this survey because of your response to an earlier survey about Fall Re-opening plans.

Your LAST Name

Your FIRST Name

Your E-mail Address

Your Phone Number

How many Genesis scholars do you have?

Clear selection

What is your occupation?

Are you REQUIRED to work AWAY from home by your employer?

Yes

Not Sure

Clear selection

Do you have an option for providing supervision for your scholar(s) during virtual learning?

Yes (for example: other family member)

Other:

Clear selection

Are you interested in having your scholar participate in a Genesis "Learning Pod"?

A "Learning Pod" is an on-site, in-person classroom in which scholars are supervised by an adult while they do virtual work. In-person instruction is NOT provided (only supervision). Physical distancing and PPE wearing are required.

Yes

Maybe

Clear selection

Would you be willing to pay a fee for on-site, "Learning Pod" services?

Yes

Other:

Clear selection

Are you interested in fee-based Early Morning Care (supervision before 8:30 a.m.) during Virtual Learning?

Yes

Clear selection

Are you interested in fee-based After School Care (tentatively from 2:30 p.m. until 6:00 p.m.) during Virtual Learning?

Yes

Clear selection

Clear form

Never submit passwords through Google Forms.

This form was created inside of Genesis Innovation Academy. Report Abuse

Forms