Coronavirus (COVID-19) Pine Hill & South Bay Family Impact Survey
Hello Pine Hill and South Bay families!

As we gear up for Distance Learning to begin the 2020-21 school year, I like to ask that you take this 5-10 minute survey to help me get a clear picture of the impacts that Coronavirus/COVID-19 have had on you and your family.

The collective Pine Hill and South Bay specific information you provide will be used to help me bring awareness to various non-profit, educational, and philanthropic foundations/organizations. My aim is to make sure you get the resources you need to meet this challenging moment.

Please note, this is not an application for medical or financial assistance.

Thank you in advance for taking the time to help our non-profit, educational, and philanthropic partners learn about the impacts the Coronavirus/COVID-19 have had on our school community. Please take good care.

My Very Best,

Gary Storts
Superintendent, South Bay Union Elementary
Impact of Coronavirus/COVID-19
The Coronavirus/COVID-19 can have many different impacts on a family. In the past two weeks, while also looking forward two weeks, how will/has COVID-19 impacted the needs of your household? Click all that apply.
Wages and Employment
Medical and Health
Family and Well-Being
Education and Schooling
Impact of the Coronavirus/COVID-19 on the Household
Please include all household members when reporting the Household Composition
Number of children 5 years old and younger
Number of Children 6 to 18 years old
Number of Adults from 19 to 59 years old
Number of Adults 60 to 69 years old
Number of Adults 70 years and above
Total Number of Household Members
Adult Household Member Information
Please complete the following section for primary household member
Which of the following best describes the primary household member's employment status on August 1, 2020?
Clear selection
Does this adult have access to health insurance (public or private)?
Clear selection
Is there a second (2nd) adult 19 years of age or older in the household?
Clear selection
Household Demograpghics (OPTIONAL)
All of the questions in this section are optional
Which of the following best represent the household member(s) race and/or ethnicity (select all that apply).
What is the primary language spoken at home?
Clear selection
What was the total household income before taxes in 2019?
Clear selection
Is there someone in your household who has a disability?
Clear selection
Does the household rent or own this home?
Clear selection
In case of an emergency, does the household have enough money to cover one month of expenses (rent utilities, groceries, basic supplies)?
Clear selection
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