School & Family Partnership Form

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Partnering with your family is key to supporting and helping all of us be successful in school. This short survey will take less than 10 minutes to fill out. The information you provide will be used in our efforts to connect you with community resources and assistance. Ensure we have correct contact information to speed up our response rate.

We look forward to helping and value your trust!

What is your name? *

What are your student(s)' names? *

What school(s) do your children attend? *

What is the best phone number to reach you with? *

What is your address? *

What is your email address? *

What is the best way to reach you? *

Phone call

Text Message

Home Visit

Mail

Other:

Are you currently experiencing housing instability?

Yes

Prefer not to answer

Other:

Clear selection

Are you currently experiencing food insecurity?

Yes

Prefer not to answer

Other:

Clear selection

Are there any unmet healthcare needs within your family?

Yes

Prefer not to answer

Other:

Clear selection

Do you have concerns about your child's access to childcare?

Yes

Prefer not to answer

Other:

Clear selection

Do you have consistent access to laundry facilities?

Yes

Prefer not to answer

Other:

Clear selection

Do you know about after school programs that your children can participate in?

Yes

Other:

Clear selection

Does your child/children struggle with regular school attendance?

Yes

Somewhat

Other:

Clear selection

What challenges do you face when getting your student(s) to school?

Suggestion box: What kind of support would be the most helpful to you right now?

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