Family Assistance Survey
It is the desire of Dufur School District to assist our families by providing information and referrals to services in our community.  Please fill out this form, and someone will be in contact with you.  You can also contact our Family Liaison by calling 541-467-2509, ext. 204.
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1. Date *
MM
/
DD
/
YYYY
2. Name *
3. Street address or mailing address *
4. Phone number *
5. Email address *
6. Please list your child or children by first name, last name, grade and age
Example,
John Doe, 4th, 9 years
Jane Doe, 2nd, 7 years
 *
7. Current family need (Check all that apply)
8. Other need not listed above (please describe)
9. By clicking this button you authorize a representative of the Dufur School District to provide your name and contact information and to disclose the information listed in this form for the purpose of connecting you and your family to support programs.  This permission to exchange information is valid for 12 months. *
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