Answer each question as honestly as possible about your parent/guardian.

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* 1. First Name

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* 2. Last Name

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* 3. Excitement- My parent verbally expresses excitement and enthusiasm about my education.

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* 4. Encouragement- If I make an unsatisfactory grade my parent maintains a positive attitude while motivating them to do better.

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* 5. Consistency- My parent intentionally encourage me before I start my school work.

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* 6. Passion- My parent is enthusiastic and engaged whether I am performing well or not.

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* 7. Sharing- My parent lets other people know how proud they are of me.

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* 8. Communication-  I have weekly positive conversations with my parent about my school experiences.

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* 9. Quality Time- On average my parent gives me at least 2 minutes of  undivided attention each school week.

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* 10. Advisement- My parent helps me think about ways to find solutions to classwork problems.

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* 11. Advisement- My parent helps me think about ways to find solutions to social problems with classmates.

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* 12. Care- My parent communicates that they care about how I feel.

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* 13. Connection- My parent consistently shows me that they are in my corner during the good and the bad times.

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* 14. Development - My parent sits down with me and helps me with
homework and academics.

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* 15. Modeling - My parents shows me how to positively interact with peers.

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* 16. Involvement - My parent participates in parent involvement activities available through my school.

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* 17. Experiences- My parent shows me examples of what success in life looks like.

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* 18. What areas do you want your parent to improve upon to help you succeed in school and life?

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* 19. What did you like most about the 3C Parent TV episode?

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* 20. What connection did you enjoy the most?

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* 21. What topics do you think we should include in our future family and parent videos?

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* 22. What are some things you would like for us to specifically teach your parent through our family videos?

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* 23. Your Cell Number

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* 24. Your Instagram Name (Optional)

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* 25. Your Email

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* 26. Parent First Name

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* 27. Parent Last Name

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* 28. Parent Email

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* 29. Parent Cell

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* 30. Gender

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* 31. Ethnicity

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