Weather Related Feedback Survey
In an effort to determine how many students of the Dierks School District are currently affected by the loss of water, please complete this survey so we can best serve our students.
* Required
Student(s)
Your answer
Grade
*
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Required
Current status of water in household
*
We currently have water in our household.
We currently have no water due to plumbing issues
We currently have no water due to the supply from water system
Required
Area of District
*
Choose
Dierks city limits
Fellowship
Mt. Caramel
Newhope
North Howard
Lockesburg
Provo
Other
Address
*
Your answer
Person Completing Survey
*
Your answer
Phone Number
*
Your answer
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