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* 1. Please select the school(s) your children attend.

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* 2. How many children attend a Memphis Shelby County School?

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* 3. What are the ages of the children living in your household for which you are the LEGAL GUARDIAN? Please select all that apply. 

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* 4. How many people currently live in your household (including yourself)?

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* 5. What is your marital status?

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* 6. What is your relationship to the child(ren) in your household? Please select all that apply.

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* 7. What is your relationship to the child(ren) in your household? Please select all that apply.

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* 8. How long have you lived in Memphis and/or Shelby County?

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* 9. What is the highest level of education you have completed? 

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* 10. What is your total household income?

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* 11. Does your child have a part-time job?

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* 12. Which, if any, of the benefits and/or services below do you currently receive?

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* 13. Many families have a number of strengths as well as challenges. From the statements listed below, please indicate how well each characteristic describes your family.

  Please select a choice below.
In my family, we talk about problems.
When we argue, my family listens to "both sides of the story."
In my family, we take time to listen to each other. 
My family pulls together when things are stressful.
My family is able to solve our problems.

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* 14. Raising children can be challenging. Please indicate how often each statement applies to your in thinking about the relationship with your youngest child living in your home.

  Please select a choice below.
There are many times when I don't know what to do as a parent.
I know how to help my child learn.
My child misbehaves just to upset me.
I praise my child when s/he behaves well. 
I have a hard time controlling my temper when I discipline my chid. 
I am happy being with my child. 
My child and I are very close to each other. 
I am able to soothe my child when s/he is upset. 
I spend time with my child doing what s/he likes to do. 
I worried that someone will harm, threaten, or take something from my child at school. 

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* 15. Thinking about the times when you feel overwhelmed or stressed, in general would you say that you:

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* 16. How many times have you or someone in your family...

  Number of Days
read, looked at books, or told stores with your child(ren) in the past week?
sang, played and listened to music, played games, or did other learning activities with your child(ren)?
gotten together with another family for play dates, trips to the park, etc.?
ate at least one meal together in the past week?

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* 17. Please estimate the number of books in your home.

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* 18. What do you think are the greatest challenges for accessing parent resources?

 
Parents don't know all the services the community offers
Families who don't fall within an "eligible group" often miss out on parenting resources that could be available to them
There is a lack of an array of prevention services for parents of children birth to years olf
Support to access parenting services are not always available (e.g., childcare, transportation)
There is a lack of ongoing training on diverse topics for parents

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* 19. Please check if you need any of the services below:

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* 20. Please select which of the following workshops, if any, you would attend if we were able to offer them.

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* 21. Please respond to the school safety items based on the current school year.

 
I feel welcome at my child's school.
My son or daughter generally behaves well in the classroom
My child feels safe in the lunchroom/cafeteria.
My child feels safe in school restrooms.
My child feels safe in the hallways.
My child feels safe going to and coming from school.
My child feels safe in school play areas.
Threats by one student against another are common in the school.
Physical fighting or conflicts happen regularly at school.
Name calling, insults or teasing happen regularly at school. 
Parents are involved in activities at school. 

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* 22. On average, how often is your child absent from school?

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* 23. When your child is absent from school, which of the following is the leading cause.

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* 24. Currently, which of the following do you consider the best way to get updates and information about the school and/or District?

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* 25. Outside of school does your child or family have access to:

 
Personal hygiene products (e.g., shampoo, soap, feminine products, toothbrush)?
Equipment to prepare meals (e.g., microwave, stove, plates, utensils)?
Technology (e.g., computer/laptop, internet, mobile phone)?
School supplies (e.g., markers, posterboards, glue)

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* 26. When is the best time for IN-PERSON school or district meetings or workshops?

 
Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
Saturdays
Sundays

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* 27. When is the best time for VIRTUAL school or district meetings or workshops?

 
Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
Saturdays
Sundays

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* 28. What are the things you like most about your school or district? What are we doing right?

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* 29. What are the things you like least about your school or district? What would you like to see the school or district do differently?

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* 30. Please share any additional information about family needs you believe would be helpful below. 

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