YSC Campbell County Parent Survey Question Title * 1. Number in Household 1 adult 2 adult 3 or more adult 1 child 2 children 3 children 4 or more children Question Title * 2. Do you have: Private Insurance No Insurance Medicaid K-Chip Question Title * 3. Do your children receive? Free lunch Reduced lunch Neither Question Title * 4. Are you a gradpaent or relative raising students in CCS? Yes No Question Title * 5. Is there someone in your family in the military? Yes No Question Title * 6. Do you need assistance with any of the following? Clothing Housing Finanacial Assistance (utilities/rent) Food School Supplies Holiday Assistance Question Title * 7. Do you take your child to the dentist? 2X's a year 1X a year Never Question Title * 8. Do you need information/assistance obtaining any of the following medical/mental health services? Medical Needs Hearing Immunizations Vision/glasses Physicals Depression/Anxiety Question Title * 9. Are you concerned about your child abusing any of the following: Tobacco Alcohol Marijuana Prescription Drugs Other Question Title * 10. Would you like to receive information regarding any of the above? Yes No Question Title * 11. Does your child have access to a computer at home? Yes No Question Title * 12. Would you be interested in any of the following programs? We will offer programs if we receive enough interest otherwise we may be able to refer you to a program. GED Preparation Coupon Shopping Literacy Skills Job Training Budgeting Substance Abuse Parenting Skills Internet Safety Summer Camps Question Title * 13. Would you like your child to participate in one of the following counseling/groups: Grief Study Skills Time Management Bullying Divorce Sexual Abuse Self Esteem Social Skills Career Readiness Anger Management Is there anything else you would like to share with us that we did not ask? Done