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The form "Petal Elementary School Parent Survey" is no longer accepting responses.

Try contacting the owner of the form if you think this is a mistake.

The purpose of this survey is to gather information on the needs at PES that could be addressed by the school counselor. The survey is part of a broader effort to develop a school counseling program at PES. Participation in the survey is completely voluntary. All personal information is strictly confidential and no names will be disclosed. Please complete a survey for each of your children who attend PES.

Child's name (optional)

Child's Gender

Male

Female

Clear selection

Child's Grade Level

3rd

4th

Clear selection

Child's Teacher

Is there an adult (administrator, teacher, staff) at PES your child feels they can talk to when they have a problem?

Yes

Clear selection

Please add any comments to the previous question here.

Does PES value diversity of children's backgrounds?

Yes

Clear selection

How comfortable are you in approaching a teacher about concerns you may have regarding your child?

Not comfortable at all

Somewhat comfortable

Extremely comfortable

Clear selection

Please add any comments to the previous question here.

Over the past two weeks, which of the following has your child most commonly displayed at home?

Anxious

Boredom

Difficulty sitting still

Difficulty making friends

Difficulty concentrating on tasks

Difficulty sleeping

Disruptive behaviours (tantrums, yelling, etc.)

Easily angered

Easily distracted

Forgetful

Learning difficulties

Poor self-esteem

Quiet/Withdrawn

Sad

Shy

None of the above

Other behavior challenges

Has your child experienced a loss in the past year?

Yes

Clear selection

If yes, please explain.

Has your child experienced any trauma in the past year?

Yes

Clear selection

If yes, please explain.

Do you feel that the behaviors, loss or trauma indicated above have contributed to your child's academic performance?

Yes

Clear selection

Please explain.

My child has been teased, picked on, made fun of, etc. by another STUDENT at PES.

Never

Rarely

Often

Clear selection

Please describe.

My child has been treated with kindness and respect by teachers and staff at PES.

Yes

Clear selection

The teachers at PES have the needed skills to meet my child's emotional, behavioral and social needs?

Yes

Clear selection

Please list any comments to the previous question here.

How confident are you in your ability to help your child deal with his/her emotions appropriately?

Not confident at all

Somewhat confident

Extremely confident

Clear selection

What do you believe are the top three needs for PES?

Choose services you would like to see for your child(ren) at PES. Services relating to...

Bereavement/grief

Setting and carrying out goals

Managing conflict with others

Divorce

Study skills and organization

Drugs/alcohol

Nutrition and a healthy lifestyle

Dealing with people of a different ethnicity, race or religion

Getting along with others

Self esteem

Stress management

Family relationships/blended families

Problem solving

School/classroom behavior

None of these

Other:

Please use this space for additional information, concerns or comments.

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