CAP Parent Survey
Dear Parent/Guardian,
We hope you have read the materials in this packet and found it helpful. To help us measure our effectiveness and impact, your response is very important. We thank you for your time in completing this questionnaire.

Raina Jones
Family Service, Inc.
CAP Coordinator
812-372-3745

My child is in ______ grade?
What school does your child attend?
Your answer
How would you rate the overall importance of the materials included in the "parent packet" your child brought home?
How do you rate the helpfulness of the materials to you and/or your child?
Which two items, if any, were most helpful or important?
Your answer
Which item, if any, was least helpful or unimportant?
Your answer
Is there other information you would like to see included? if so, what information?
Your answer
Did your child talk with you about the "Kids on the Block" puppet program or "Anti-Bully" program they saw?
Did materials in the "parent packet" help support you to have a conversation with your child?
Your name and address: (optional)
Your answer
Anything else you want us to know? Thank you!!
Your answer
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