McKittrick Elementary School's Incoming Student Survey

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* 1. Do you physically reside within the McKittrick School district full time?

Yes

No

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* 2. What is your address?

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* 3. Do you have a PG&E Bill that verfies your address?

Yes

No

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* 4. Do you have any children that are 0-4 Years old?

Yes

No

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* 5. How many children do you have that are 0-4 years old?

One

Two

Three

Four

More

I do not have any children.

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* 6. How old is your oldest child that is 0-4 year old?

0

1

2

3

4

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* 7. What is your 0-4 Year old Child's birth date?

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* 8. Are you planning on your student / s attending McKittrick Elementary School?

Yes

No

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* 9. What is your name?

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* 10. What is your mailing address?

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* 11. What is your phone number?

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* 12. What is your email address. Put NA if you do not have one.

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* 13. What is today's Date

Date / Time

Date