JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Todd County YSC Parent Assessment 2023-2024 (TCMS and TCCHS parents/guardians only)
The results of this survey will be used in program planning for your school's Youth Services Center. If you have any questions or need further assistance please contact Sarah Latham at TCMS or Kelli Templeman at TCCHS. Thank you. This survey is intended for parents of middle and high school students and is anonymous unless you request specific services to where you will be prompted to include your name.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Which school does your child attend? (Check all that apply)
TCMS
TCCHS
TCHA
About your Family? (check all that apply)
Single-parent home
New or expecting parent
Raising a realtive's child (grandchild, niece/nephew, etc.)
Blended family (step-family)
I have a child with special needs (learning, health, behavioral, etc.)
We are a military family
There is a parent in the home without a high school diploma
Either I have or another caregiver has experienced incarceration
None of the above
Which of the following do you think your tween/teen needs more information about?
*
Dealing with divorce
Family counseling
Teen counseling
Tobacco/Alcohol/Drug Use and Abuse
Teen pregnancy
Abuse/Neglect
Self-esteem issues
Dealing with grief
Emergency assistance: food, clothing, school supplies, housing, medical needs
Information on where to get help
Diet/Exercise
Vision and/or health problems
Planning for the future: job training and employment
Being a friend/fitting in
After-school or summer enrichment activities
Role model/Mentor
Required
Did you graduate from high school or obtain a GED?
*
Your answer
I feel confident assisting my child with their homework?
Yes
No
Sometimes
Clear selection
What do you think are the top 3 social/emotional issues that interfere with student learning?
Fitting In/Self-Esteem
Dating Issues
Social Media
Peer Pressure
Bullying
Lack of Respect
Poor Parent-Youth communication
Need for mentors/therapists
Lack of family engagement
Conflict with peers
Family Challenges (Divorce, Illness, Financial, etc...)
Other:
What do you think are the top 3 health issues that interfere with student learning?
Lack of exercise
Lack of sleep
Diet/Hunger, Nutrition
Vision issues
Hearing issues
Mental health/suicidal thoughts
Alcohol, tobacco and other drugs
Health issues (chronic illness, sleep issues, ADD/ADHD
Other:
Would you be interested in your child having more afterschool or summer enrichment programs?
Yes
No
Maybe
Clear selection
If interested in after-school programming for students, what barriers currently exist for your family?
Transportation/gas costs
Lack of availability
Location
Time of programming
Childcare
Employment/Work conflicts
At any time during the last year, did you receive any assistance for your child(ren) with any of the following? (check all that apply)
Clothes or shoes
Food
School supplies
Medical/Dental/Vision Care
Household goods and/or hygiene products
Child Care
Crisis assistance (utilities, heat, housing, etc.)
Other:
Additional comments and/or suggestions of programs and information you would like from the Youth Services Center?
Your answer
Do you anticipate needing assistance with basic needs, Angel Tree program, school supplies, clothes/shoes, etc...in the following school year? If you answer yes, you will be directed to Section 2 of this form to provide additional information.
Yes
No
Clear selection
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of TODD COUNTY.
Report Abuse
Forms
