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Hardship Survey Explore Academy Rio Rancho
Please fill out these survey to report hardships ( financial, homelessness, or other adverse situations) to the school so we can help. We want all students to succeed at Explore Academy Rio Rancho, regardless of their situation outside of school. As a school & community, we want to be able to support as best we can. 
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Email *
Date  *
MM
/
DD
/
YYYY
Parent/Guardian name
First and Last
 *
Student(s) name
First and Last
 *
My family and I are having trouble with: 
(check all that apply)
 *
Required
If "Other" is selected above, I am struggling with:
To help in connecting families with additional services, please answer the following housing questions to the best of your ability. Where has the student normally slept in the past 30 days? *
Is the home or place student sleeps at night connected to electricity, heat and running water? *
Does the home or place the student sleeps at night have problems with mold, vermin (lice, rodents, fleas, etc.) or have other significant issues? *
Do you have an adequate number of bedrooms/beds for the number of people living in the home?  *
I would like someone to contact me by:
I would like someone to contact me by phone at this number:
I would like someone to contact me by email at this email address:
I would like someone to contact me by postal mail at this address:
I would like someone to contact me through a letter sent with my child(ren)
Clear selection
Day(s) and time(s) a parent/guardian is available to come in?
Submit
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