Parent/Guardian Survey: School-Based Therapy Program
Name and phone number are optional. You may also send feedback to
. If you are experiencing an emergency and need immediate assistance, please dial 911.
Which school district does your student attend?
Which school campus did your student attend at the time of referral?
Please choose the grade your student was in when he/she received services.
What is the last name of your student's assigned school counselor (if applicable)?
If you don't know, please type "I don't know"
What is the first and/or last name of the SBT your student met with weekly?
If you don't know, please type "I don't know".
Approximately, how many weeks did your student meet with a School-Based Therapist?
Less that 8 weeks
8 weeks or more
Would you recommend this program to another parent/guardian for their student?
What did you like about this program, and why?
Please share with us what was most valuable for you and/or your student, and why.
Is there something about this program you would like to see changed?
If you answered yes above, please share with us what you would like to see changed.
Your Phone Number
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