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* 1. Student First and Last Name AND Grade (please list all students in your household)

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* 2. Do you have internet/computer/technological capability to receive, return, and communicate about schoolwork?

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* 3. If you answered "No" to question #2, what is needed to be able to achieve this?

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* 4. Supplemental Learning Materials are available during the school closure and available to each student(s) by computer or paper/pencil packets. Which do you prefer for your student(s)?

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* 5. If you prefer getting materials in a paper/pencil packet, what is the best delivery method for you?

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* 6. Would counseling services be helpful if there are issues in the household causing stress or trauma?  If so, please provide name and grade (if applicable) of the person(s) needing support.  We will forward your information to the appropriate school counseling personnel.

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* 7. We are providing free meals (breakfast and lunch) daily to children ages 1-18.  These can be picked up at the Vernonia Schools Building from 11 a.m. - 12 noon and at the Mist Grade School from 11:30 a.m. - 12 noon Monday - Friday.   How many children in your household are currently picking up meals at one of our two sites?

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* 8. Would you want/need/accept these meals if they were delivered closer to your home? 

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* 9. If your job is considered "Essential", and you need assistance with childcare, what days and times do you need?

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* 10. As we continue to communicate with our students and families, which methods do your prefer?

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