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CMS Family Needs Assessment 2021-2022
Hi everyone! We at CMS are very excited to get to know you and your student(s) this year! Please fill out this form and let us know more about your family. We greatly appreciate any information you can give us about your student(s) and any needs/concerns you may have. This information will only be used to help assist your student in being successful while at CMS. The information provided will be viewed by the administrators and counselor and will only be shared with teachers on a need-to-know basis.
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* Indicates required question
Your Name:
*
First and Last
Your answer
Your Student(s) Name:
*
List all students living in your household
Your answer
Student's Grade
*
5th
6th
7th
8th
Required
Your relation to the student(s):
*
i.e. "Mom, Grandfather, uncle" etc.
Your answer
Would you be interested in virtual parent workshops on specific topics?
*
Such as how to navigate schoology, how to read test scores, etc.
Yes
No
Social/Emotional areas of concern or growth for your student:
*
Check all that apply.
goal setting
organization
time management
making friends
test anxiety
depression
anxiety
self-harm
Other:
Required
Academic content areas of concern or growth for your student:
*
Check all that apply.
Reading
Writing
Math
Science
Social Studies
Required
Any basic needs your family may need at this time:
i.e. "Toiletries, food, water" etc. These are not guaranteed to be fulfilled, but we will assist as best we can.
Your answer
Will your student need assistance with school supplies due to financial reasons?
*
Yes
No
Which scenario best describes your student's ability to access WiFi/ the internet at your home?
*
We have a solid WiFi connection and/or access to the internet at our home.
We have limited access to the internet at our home (primarily via cell phone).
We have no access to the internet at our home.
I need information on possible alternate internet connection options.
*
Yes
No
Which of the following devices do you have that can help your student access the internet? (Check all that apply.)
*
Check all that apply.
Desktop Computer (Windows)
Laptop Computer (Windows)
iMac (Apple-Desktop)
MacBook (Apple-Laptop)
iPad (Apple)
Chromebook
Surface Pro
Kindle
Nook
iPhone
Android
Video Gaming System
Other Device
Required
I would need access to a school device to assist my student.
*
Yes
No
Anything you feel we should know about your student or family situation?
Please list as much information as you feel comfortable sharing.
Your answer
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