Service Matching & Student Health Questionnaire Survey

The purpose of this survey is to determine your level of satisfaction with the Stakeholders Collaboration to Improve Student Health Service Matching Initiative and to gain an understanding of student health at your school. Through the Service Matching Initiative, the Stakeholders Collaboration matches schools with community health programs and services. Your responses will be kept confidential and will be used so we can improve our services to you.

This three-section questionnaire should take no more than 5 minutes to complete. Thanks in advance for your time and input!

Please choose your answers based on the program(s) and/or service(s) that were brought to your school through Stakeholders Service Matching.

*
1. Please rate your level of satisfaction with the program(s) and/or service(s) that were brought into your school.


Arthritis Education	Please rate your level of satisfaction with the program(s) and/or service(s) that were brought into your school. Arthritis Education
Asthma Management	Asthma Management
Be Red Cross Ready	Be Red Cross Ready
Body Walk-An Engaging Education Experience	Body Walk-An Engaging Education Experience
Breakfast in the Classroom	Breakfast in the Classroom
Cancer in the Classroom	Cancer in the Classroom
Chicago Partnership for Health Promotion	Chicago Partnership for Health Promotion
Chicago Runners	Chicago Runners
Child and Family Connections	Child and Family Connections
Common Threads/Cooking Skills and World Cuisine	Common Threads/Cooking Skills and World Cuisine
Community Disaster Education	Community Disaster Education
CPR & First Aid Certification	CPR & First Aid Certification
Creating a Physically Active School Environment	Creating a Physically Active School Environment
Ease the Tease	Ease the Tease
Eat, Act, Think	Eat, Act, Think
E-Etiquette: Internet Safety	E-Etiquette: Internet Safety
Epilepsy Classroom	Epilepsy Classroom
Expanded Food and Nutrition Education Program	Expanded Food and Nutrition Education Program
Family Caregiving	Family Caregiving
FAN for Youth	FAN for Youth
Fight Asthma Now (FAN) for Teens	Fight Asthma Now (FAN) for Teens
First Aid for Little People	First Aid for Little People
Fresh From the Farm	Fresh From the Farm
Gang Awareness	Gang Awareness
Getting Health Insurance and Care in IL	Getting Health Insurance and Care in IL
Grief, Loss, and the Transition Back to the Classroom Healthy Me	Grief, Loss, and the Transition Back to the Classroom Healthy Me
Healthy Snacks Workshop	Healthy Snacks Workshop
Hip-Hop Yoga	Hip-Hop Yoga
Home Alone	Home Alone
In My Shoes	In My Shoes
Kid Fire Stopper	Kid Fire Stopper
Knee Injury Prevention Program	Knee Injury Prevention Program
Leadership Development Through Sports	Leadership Development Through Sports
Let's Get Real	Let's Get Real
Managing Students with Seizures	Managing Students with Seizures
Mayor Daley's Safe Routes Ambassadors	Mayor Daley's Safe Routes Ambassadors
Mental Illness Training	Mental Illness Training
Mission: Nutrition	Mission: Nutrition
Nutrition A3	Nutrition A3
Responsibility Counts	Responsibility Counts
Ronald McDonald Care Mobile	Ronald McDonald Care Mobile
Safe and Free-Safety Lessons	Safe and Free-Safety Lessons
Safety for All: Addressing Anti-LGBTQ Bullying and Harassment	Safety for All: Addressing Anti-LGBTQ Bullying and Harassment
School Walk for Diabetes	School Walk for Diabetes
Scrubby Bear	Scrubby Bear
Seizure Training for School Personnel	Seizure Training for School Personnel
Seizures and You: Take Charge of the Facts	Seizures and You: Take Charge of the Facts
Sexual Health Resources	Sexual Health Resources
Show some Respect	Show some Respect
Speaker's Bureau	Speaker's Bureau
Stretch-n-Grow	Stretch-n-Grow
Walk Across Illinois	Walk Across Illinois
Wellness Training and Professional Development	Wellness Training and Professional Development
What's Behind Our Eyes	What's Behind Our Eyes
Work to Play Program	Work to Play Program
Yoga and Wellness for Students with Special Needs	Yoga and Wellness for Students with Special Needs
Yoga Ed.	Yoga Ed.
Youth Alternatives	Youth Alternatives
Youth Tobacco Action Network	Youth Tobacco Action Network

Comments

*
2. Would you bring this program(s) and/or service(s) into your school again?


Arthritis Education	Would you bring this program(s) and/or service(s) into your school again? Arthritis Education
Asthma Management	Asthma Management
Be Red Cross Ready	Be Red Cross Ready
Body Walk-An Engaging Education Experience	Body Walk-An Engaging Education Experience
Breakfast in the Classroom	Breakfast in the Classroom
Cancer in the Classroom	Cancer in the Classroom
Chicago Partnership for Health Promotion	Chicago Partnership for Health Promotion
Chicago Runners	Chicago Runners
Child and Family Connections	Child and Family Connections
Common Threads/Cooking Skills and World Cuisine	Common Threads/Cooking Skills and World Cuisine
Community Disaster Education	Community Disaster Education
CPR & First Aid Certification	CPR & First Aid Certification
Creating a Physically Active School Environment	Creating a Physically Active School Environment
Ease the Tease	Ease the Tease
Eat, Act, Think	Eat, Act, Think
E-Etiquette: Internet Safety	E-Etiquette: Internet Safety
Epilepsy Classroom	Epilepsy Classroom
Expanded Food and Nutrition Education Program	Expanded Food and Nutrition Education Program
Family Caregiving	Family Caregiving
FAN for Youth	FAN for Youth
Fight Asthma Now (FAN) for Teens	Fight Asthma Now (FAN) for Teens
First Aid for Little People	First Aid for Little People
Fresh From the Farm	Fresh From the Farm
Gang Awareness	Gang Awareness
Getting Health Insurance and Care in IL	Getting Health Insurance and Care in IL
Grief, Loss, and the Transition Back to the Classroom Healthy Me	Grief, Loss, and the Transition Back to the Classroom Healthy Me
Healthy Snacks Workshop	Healthy Snacks Workshop
Hip-Hop Yoga	Hip-Hop Yoga
Home Alone	Home Alone
In My Shoes	In My Shoes
Kid Fire Stopper	Kid Fire Stopper
Knee Injury Prevention Program	Knee Injury Prevention Program
Leadership Development Through Sports	Leadership Development Through Sports
Let's Get Real	Let's Get Real
Managing Students with Seizures	Managing Students with Seizures
Mayor Daley's Safe Routes Ambassadors	Mayor Daley's Safe Routes Ambassadors
Mental Illness Training	Mental Illness Training
Mission: Nutrition	Mission: Nutrition
Nutrition A3	Nutrition A3
Responsibility Counts	Responsibility Counts
Ronald McDonald Care Mobile	Ronald McDonald Care Mobile
Safe and Free-Safety Lessons	Safe and Free-Safety Lessons
Safety for All: Addressing Anti-LGBTQ Bullying and Harassment	Safety for All: Addressing Anti-LGBTQ Bullying and Harassment
School Walk for Diabetes	School Walk for Diabetes
Scrubby Bear	Scrubby Bear
Seizure Training for School Personnel	Seizure Training for School Personnel
Seizures and You: Take Charge of the Facts	Seizures and You: Take Charge of the Facts
Sexual Health Resources	Sexual Health Resources
Show some Respect	Show some Respect
Speaker's Bureau	Speaker's Bureau
Stretch-n-Grow	Stretch-n-Grow
Walk Across Illinois	Walk Across Illinois
Wellness Training and Professional Development	Wellness Training and Professional Development
What's Behind Our Eyes	What's Behind Our Eyes
Work to Play Program	Work to Play Program
Yoga and Wellness for Students with Special Needs	Yoga and Wellness for Students with Special Needs
Yoga Ed.	Yoga Ed.
Youth Alternatives	Youth Alternatives
Youth Tobacco Action Network	Youth Tobacco Action Network

Other (please specify)

*
3. Was the presenter prepared for his/her program?


Arthritis Education	Was the presenter prepared for his/her program? Arthritis Education
Asthma Management	Asthma Management
Be Red Cross Ready	Be Red Cross Ready
Body Walk-An Engaging Education Experience	Body Walk-An Engaging Education Experience
Breakfast in the Classroom	Breakfast in the Classroom
Cancer in the Classroom	Cancer in the Classroom
Chicago Partnership for Health Promotion	Chicago Partnership for Health Promotion
Chicago Runners	Chicago Runners
Child and Family Connections	Child and Family Connections
Common Threads/Cooking Skills and World Cuisine	Common Threads/Cooking Skills and World Cuisine
Community Disaster Education	Community Disaster Education
CPR & First Aid Certification	CPR & First Aid Certification
Creating a Physically Active School Environment	Creating a Physically Active School Environment
Ease the Tease	Ease the Tease
Eat, Act, Think	Eat, Act, Think
E-Etiquette: Internet Safety	E-Etiquette: Internet Safety
Epilepsy Classroom	Epilepsy Classroom
Expanded Food and Nutrition Education Program	Expanded Food and Nutrition Education Program
Family Caregiving	Family Caregiving
FAN for Youth	FAN for Youth
Fight Asthma Now (FAN) for Teens	Fight Asthma Now (FAN) for Teens
First Aid for Little People	First Aid for Little People
Fresh From the Farm	Fresh From the Farm
Gang Awareness	Gang Awareness
Getting Health Insurance and Care in IL	Getting Health Insurance and Care in IL
Grief, Loss, and the Transition Back to the Classroom Healthy Me	Grief, Loss, and the Transition Back to the Classroom Healthy Me
Healthy Snacks Workshop	Healthy Snacks Workshop
Hip-Hop Yoga	Hip-Hop Yoga
Home Alone	Home Alone
In My Shoes	In My Shoes
Kid Fire Stopper	Kid Fire Stopper
Knee Injury Prevention Program	Knee Injury Prevention Program
Leadership Development Through Sports	Leadership Development Through Sports
Let's Get Real	Let's Get Real
Managing Students with Seizures	Managing Students with Seizures
Mayor Daley's Safe Routes Ambassadors	Mayor Daley's Safe Routes Ambassadors
Mental Illness Training	Mental Illness Training
Mission: Nutrition	Mission: Nutrition
Nutrition A3	Nutrition A3
Responsibility Counts	Responsibility Counts
Ronald McDonald Care Mobile	Ronald McDonald Care Mobile
Safe and Free-Safety Lessons	Safe and Free-Safety Lessons
Safety for All: Addressing Anti-LGBTQ Bullying and Harassment	Safety for All: Addressing Anti-LGBTQ Bullying and Harassment
School Walk for Diabetes	School Walk for Diabetes
Scrubby Bear	Scrubby Bear
Seizure Training for School Personnel	Seizure Training for School Personnel
Seizures and You: Take Charge of the Facts	Seizures and You: Take Charge of the Facts
Sexual Health Resources	Sexual Health Resources
Show some Respect	Show some Respect
Speaker's Bureau	Speaker's Bureau
Stretch-n-Grow	Stretch-n-Grow
Walk Across Illinois	Walk Across Illinois
Wellness Training and Professional Development	Wellness Training and Professional Development
What's Behind Our Eyes	What's Behind Our Eyes
Work to Play Program	Work to Play Program
Yoga and Wellness for Students with Special Needs	Yoga and Wellness for Students with Special Needs
Yoga Ed.	Yoga Ed.
Youth Alternatives	Youth Alternatives
Youth Tobacco Action Network	Youth Tobacco Action Network

Other (please specify)

*
4. Was the presenter on time for his/her program?


Arthritis Education	Was the presenter on time for his/her program? Arthritis Education
Asthma Management	Asthma Management
Be Red Cross Ready	Be Red Cross Ready
Body Walk-An Engaging Education Experience	Body Walk-An Engaging Education Experience
Breakfast in the Classroom	Breakfast in the Classroom
Cancer in the Classroom	Cancer in the Classroom
Chicago Partnership for Health Promotion	Chicago Partnership for Health Promotion
Chicago Runners	Chicago Runners
Child and Family Connections	Child and Family Connections
Common Threads/Cooking Skills and World Cuisine	Common Threads/Cooking Skills and World Cuisine
Community Disaster Education	Community Disaster Education
CPR & First Aid Certification	CPR & First Aid Certification
Creating a Physically Active School Environment	Creating a Physically Active School Environment
Ease the Tease	Ease the Tease
Eat, Act, Think	Eat, Act, Think
E-Etiquette: Internet Safety	E-Etiquette: Internet Safety
Epilepsy Classroom	Epilepsy Classroom
Expanded Food and Nutrition Education Program	Expanded Food and Nutrition Education Program
Family Caregiving	Family Caregiving
FAN for Youth	FAN for Youth
Fight Asthma Now (FAN) for Teens	Fight Asthma Now (FAN) for Teens
First Aid for Little People	First Aid for Little People
Fresh From the Farm	Fresh From the Farm
Gang Awareness	Gang Awareness
Getting Health Insurance and Care in IL	Getting Health Insurance and Care in IL
Grief, Loss, and the Transition Back to the Classroom Healthy Me	Grief, Loss, and the Transition Back to the Classroom Healthy Me
Healthy Snacks Workshop	Healthy Snacks Workshop
Hip-Hop Yoga	Hip-Hop Yoga
Home Alone	Home Alone
In My Shoes	In My Shoes
Kid Fire Stopper	Kid Fire Stopper
Knee Injury Prevention Program	Knee Injury Prevention Program
Leadership Development Through Sports	Leadership Development Through Sports
Let's Get Real	Let's Get Real
Managing Students with Seizures	Managing Students with Seizures
Mayor Daley's Safe Routes Ambassadors	Mayor Daley's Safe Routes Ambassadors
Mental Illness Training	Mental Illness Training
Mission: Nutrition	Mission: Nutrition
Nutrition A3	Nutrition A3
Responsibility Counts	Responsibility Counts
Ronald McDonald Care Mobile	Ronald McDonald Care Mobile
Safe and Free-Safety Lessons	Safe and Free-Safety Lessons
Safety for All: Addressing Anti-LGBTQ Bullying and Harassment	Safety for All: Addressing Anti-LGBTQ Bullying and Harassment
School Walk for Diabetes	School Walk for Diabetes
Scrubby Bear	Scrubby Bear
Seizure Training for School Personnel	Seizure Training for School Personnel
Seizures and You: Take Charge of the Facts	Seizures and You: Take Charge of the Facts
Sexual Health Resources	Sexual Health Resources
Show some Respect	Show some Respect
Speaker's Bureau	Speaker's Bureau
Stretch-n-Grow	Stretch-n-Grow
Walk Across Illinois	Walk Across Illinois
Wellness Training and Professional Development	Wellness Training and Professional Development
What's Behind Our Eyes	What's Behind Our Eyes
Work to Play Program	Work to Play Program
Yoga and Wellness for Students with Special Needs	Yoga and Wellness for Students with Special Needs
Yoga Ed.	Yoga Ed.
Youth Alternatives	Youth Alternatives
Youth Tobacco Action Network	Youth Tobacco Action Network

Other (please specify)

*
5. Would you invite the presenter back to your school?


Arthritis Education	Would you invite the presenter back to your school? Arthritis Education
Asthma Management	Asthma Management
Be Red Cross Ready	Be Red Cross Ready
Body Walk-An Engaging Education Experience	Body Walk-An Engaging Education Experience
Breakfast in the Classroom	Breakfast in the Classroom
Cancer in the Classroom	Cancer in the Classroom
Chicago Partnership for Health Promotion	Chicago Partnership for Health Promotion
Chicago Runners	Chicago Runners
Child and Family Connections	Child and Family Connections
Common Threads/Cooking Skills and World Cuisine	Common Threads/Cooking Skills and World Cuisine
Community Disaster Education	Community Disaster Education
CPR & First Aid Certification	CPR & First Aid Certification
Creating a Physically Active School Environment	Creating a Physically Active School Environment
Ease the Tease	Ease the Tease
Eat, Act, Think	Eat, Act, Think
E-Etiquette: Internet Safety	E-Etiquette: Internet Safety
Epilepsy Classroom	Epilepsy Classroom
Expanded Food and Nutrition Education Program	Expanded Food and Nutrition Education Program
Family Caregiving	Family Caregiving
FAN for Youth	FAN for Youth
Fight Asthma Now (FAN) for Teens	Fight Asthma Now (FAN) for Teens
First Aid for Little People	First Aid for Little People
Fresh From the Farm	Fresh From the Farm
Gang Awareness	Gang Awareness
Getting Health Insurance and Care in IL	Getting Health Insurance and Care in IL
Grief, Loss, and the Transition Back to the Classroom Healthy Me	Grief, Loss, and the Transition Back to the Classroom Healthy Me
Healthy Snacks Workshop	Healthy Snacks Workshop
Hip-Hop Yoga	Hip-Hop Yoga
Home Alone	Home Alone
In My Shoes	In My Shoes
Kid Fire Stopper	Kid Fire Stopper
Knee Injury Prevention Program	Knee Injury Prevention Program
Leadership Development Through Sports	Leadership Development Through Sports
Let's Get Real	Let's Get Real
Managing Students with Seizures	Managing Students with Seizures
Mayor Daley's Safe Routes Ambassadors	Mayor Daley's Safe Routes Ambassadors
Mental Illness Training	Mental Illness Training
Mission: Nutrition	Mission: Nutrition
Nutrition A3	Nutrition A3
Responsibility Counts	Responsibility Counts
Ronald McDonald Care Mobile	Ronald McDonald Care Mobile
Safe and Free-Safety Lessons	Safe and Free-Safety Lessons
Safety for All: Addressing Anti-LGBTQ Bullying and Harassment	Safety for All: Addressing Anti-LGBTQ Bullying and Harassment
School Walk for Diabetes	School Walk for Diabetes
Scrubby Bear	Scrubby Bear
Seizure Training for School Personnel	Seizure Training for School Personnel
Seizures and You: Take Charge of the Facts	Seizures and You: Take Charge of the Facts
Sexual Health Resources	Sexual Health Resources
Show some Respect	Show some Respect
Speaker's Bureau	Speaker's Bureau
Stretch-n-Grow	Stretch-n-Grow
Walk Across Illinois	Walk Across Illinois
Wellness Training and Professional Development	Wellness Training and Professional Development
What's Behind Our Eyes	What's Behind Our Eyes
Work to Play Program	Work to Play Program
Yoga and Wellness for Students with Special Needs	Yoga and Wellness for Students with Special Needs
Yoga Ed.	Yoga Ed.
Youth Alternatives	Youth Alternatives
Youth Tobacco Action Network	Youth Tobacco Action Network

Other (please specify)

6. What health programs and/or services are you most in need of at your school for students, staff, and parents?

What health programs and/or services are you most in need of at your school for students, staff, and parents?

*
7. Please rate your level of agreement with these statements about your involvement with Service Matching. Choose one answer for each statement.

	Agree	Mostly Agree	Mostly Disagree	Disagree
Service Matching Programs met my needs.	*Please rate your level of agreement with these statements about your involvement with Service Matching. Choose one answer for each statement. Service Matching Programs met my needs. Agree	Service Matching Programs met my needs. Mostly Agree	Service Matching Programs met my needs. Mostly Disagree	Service Matching Programs met my needs. Disagree
I found it easy to implement and/or schedule Service Matching programs in my school.	I found it easy to implement and/or schedule Service Matching programs in my school. Agree	I found it easy to implement and/or schedule Service Matching programs in my school. Mostly Agree	I found it easy to implement and/or schedule Service Matching programs in my school. Mostly Disagree	I found it easy to implement and/or schedule Service Matching programs in my school. Disagree
I plan to use Service Matching services in the future.	I plan to use Service Matching services in the future. Agree	I plan to use Service Matching services in the future. Mostly Agree	I plan to use Service Matching services in the future. Mostly Disagree	I plan to use Service Matching services in the future. Disagree
I would recommend Service Matching to another school.	I would recommend Service Matching to another school. Agree	I would recommend Service Matching to another school. Mostly Agree	I would recommend Service Matching to another school. Mostly Disagree	I would recommend Service Matching to another school. Disagree
Service matching raised awareness on student health issues at my school.	Service matching raised awareness on student health issues at my school. Agree	Service matching raised awareness on student health issues at my school. Mostly Agree	Service matching raised awareness on student health issues at my school. Mostly Disagree	Service matching raised awareness on student health issues at my school. Disagree
Overall, participating in Service Matching programming was worthwhile experience for my school.	Overall, participating in Service Matching programming was worthwhile experience for my school. Agree	Overall, participating in Service Matching programming was worthwhile experience for my school. Mostly Agree	Overall, participating in Service Matching programming was worthwhile experience for my school. Mostly Disagree	Overall, participating in Service Matching programming was worthwhile experience for my school. Disagree

Comments

8. What can we do to improve Service Matching in the future?

What can we do to improve Service Matching in the future?

9. How did you find out about Service Matching?

How did you find out about Service Matching?

Service Matching & Student Health Questionnaire
Exit this survey

1. Section I

*
1. Please rate your level of satisfaction with the program(s) and/or service(s) that were brought into your school.

*
2. Would you bring this program(s) and/or service(s) into your school again?

*
3. Was the presenter prepared for his/her program?

*
4. Was the presenter on time for his/her program?

*
5. Would you invite the presenter back to your school?

6. What health programs and/or services are you most in need of at your school for students, staff, and parents?

*
7. Please rate your level of agreement with these statements about your involvement with Service Matching. Choose one answer for each statement.

8. What can we do to improve Service Matching in the future?

9. How did you find out about Service Matching?

Service Matching & Student Health QuestionnaireExit this survey

1. Section I

*1. Please rate your level of satisfaction with the program(s) and/or service(s) that were brought into your school.

*2. Would you bring this program(s) and/or service(s) into your school again?

*3. Was the presenter prepared for his/her program?

*4. Was the presenter on time for his/her program?

*5. Would you invite the presenter back to your school?

6. What health programs and/or services are you most in need of at your school for students, staff, and parents?

*7. Please rate your level of agreement with these statements about your involvement with Service Matching. Choose one answer for each statement.

8. What can we do to improve Service Matching in the future?

9. How did you find out about Service Matching?

Service Matching & Student Health Questionnaire
Exit this survey

*
1. Please rate your level of satisfaction with the program(s) and/or service(s) that were brought into your school.

*
2. Would you bring this program(s) and/or service(s) into your school again?

*
3. Was the presenter prepared for his/her program?

*
4. Was the presenter on time for his/her program?

*
5. Would you invite the presenter back to your school?

*
7. Please rate your level of agreement with these statements about your involvement with Service Matching. Choose one answer for each statement.