Request edit access
JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Let Parents Parent Bill, Volunteer, Parent and Teacher Survey Form
Sign in to Google
to save your progress.
Learn more
* Indicates required question
We encourage all parents to head directly to their Board of Education to report incidents of gender and LGBTQ+ indoctrination at their local schools. In addition, we encourage you to report them using this form so we can track and share information with legislators. We need them to know what is happening at schools across our state. To that end, please complete this survey and let us know how you'd like to be involved!
Additionally, please don't hesitate to express your concern to your legislators. The vast majority of legislators are unaware of what is happening in their local schools and would like to hear from you. Use this official guide to help you find your legislators: https://www.cga.ct.gov/asp/menu/cgafindleg.asp
First Name (anonymity is ok!)
Your answer
Last Name
Your answer
Phone number
Your answer
Street Address
Your answer
Town/City
*
Your answer
Zip Code
Your answer
Email Address
*
Your answer
Student's grade
*
Choose
n/a
pre-k (3 or 4)
1
2
3
4
5
6
7
8
9
10
11
12
School or District
Your answer
I am a . . .
*
retired teacher or education professional
active teacher or professional employed at a public school
active teacher or professional employed at a private school
active teacher or professional employed at a parochial school
homeschool parent
Mental health professional
parent or concerned relative
Other:
Type of Incident in Connecticut
*
Change Room at School for child to change into clothes of opposite sex
"Furry" litter box at school for children
Inappropriate survey questions
Sexual harassment of student hidden by staff
A natal boy using the girls locker room and/or competing in sports competition(s)
Hormone dispersal to students without parental notification or consent.
Supported a gender transition without parental knowledge
Supported a gender transition against a parent(s) wishes.
School is keeping a dual record to hide pronoun change.
Change of pronoun by child without parental notification
Change of pronoun by child without parental consent
My child was asked their preferred pronouns at school by a teacher or staff.
I have nothing to report but wish to be involved/volunteer.
Other:
You may provide a description of what is going on or has happened.
Your answer
What school year did this going on that you know of?
2021/2022
2022/2023
2023/2024
Other:
Clear selection
How do you think you can help.
I am willing to share my story with my legislator(s) in person.
I am willing to write an oped to my local paper (FIC can help!).
I would like to testify in person or via Zoom at a public hearing on this matter.
Other:
Clear selection
How did you discover this form?
Facebook post.
Shared with me personally.
FIC Website
Other:
Clear selection
May we contact you concerning this survey?
Yes, via phone or text.
Yes, via e-mail.
Not at this time.
Clear selection
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. -
Terms of Service
-
Privacy Policy
Does this form look suspicious?
Report
Forms
Help and feedback
Help Forms improve
Report
