TPS Truancy Mediation Participant Survey

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* 1. What is the Child's Name?

First Name:

Last Name:

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* 2. What is the date?

Date / Time

Date

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* 3. What school is this mediation taking place at?

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* 4. Did the mediator listen to you when you had your time to talk?

Yes

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* 5. Would you say that the mediator:

Favored you

Was neutral or fair to both sides

Favored the other side

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* 6. Did you understand the problem or situation better after the mediation?

Yes

Unsure

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* 7. What was the primary reason why attendance was hard for this student?

Illness of child/family member

Employment/Scheduling

Child Safety (bullying)

Childcare

Behavior

Basic Needs Lacking

Transportation

Family Violence

Housing Issue

Vacation

Mental Health

Substance Concerns

Parent/Guardian Unaware of Absence

Death in Family/Friend

Parent/Custodial Incarceration

Lack of Internet

Other Internet/Technology Issues

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* 8. How do you feel about the mediation outcome or agreement?

Satisfied

Not satisfied

Unsure

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* 9. What is your role in this mediation?

Parent/Legal Guardian

Student

Teacher

School Principal/Assistant Principal

School Counselor/Social Worker

School Nurse

Support Person

Other (please specify)

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* 10. What is your age?

Under 18

18 to 44 years

45 to 64 years

65 years and over

Prefer not to answer

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* 11. What is your race/ethnicity?

Black

White

American Indian or Alaska Native

Hawaiian

Pacific Islander

Latino or Hispanic

Asian

Multi-Racial

Other

Prefer not to answer

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* 12. What is your gender?

Female

Male

Other/Non-conforming

Prefer not to answer

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* 13. What is the highest level of school you have completed or the highest degree you have received?

Less than high school degree

High school degree or equivalent (e.g., GED)

Some college but no degree

Associate degree

Bachelor degree

Graduate degree

Prefer not to answer

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* 1. What is the Child's Name?

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* 2. What is the date?

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* 3. What school is this mediation taking place at?

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* 4. Did the mediator listen to you when you had your time to talk?

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* 5. Would you say that the mediator:

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* 6. Did you understand the problem or situation better after the mediation?

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* 7. What was the primary reason why attendance was hard for this student?

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* 8. How do you feel about the mediation outcome or agreement?

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* 9. What is your role in this mediation?

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* 10. What is your age?

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* 11. What is your race/ethnicity?

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* 12. What is your gender?

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* 13. What is the highest level of school you have completed or the highest degree you have received?

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* 14. This program is funded by ODJFS, and they wish to hear your comments... please share.