Blaze Questionnaire

Tell us more about your journey so far for student success!

Please complete the following form as your district prepares to blaze a trail for the whole child. Once received, we will follow up with you to continue the conversation.

Question Title

* 1. Please check the appropriate column for your level of interest for each of the items.

	Very Interested	Interested	Not Interested
Integrate student health and wellness needs into strategic planning, existing health & wellness committees, and/or student support teams.	Integrate student health and wellness needs into strategic planning, existing health & wellness committees, and/or student support teams. Very Interested	Integrate student health and wellness needs into strategic planning, existing health & wellness committees, and/or student support teams. Interested	Integrate student health and wellness needs into strategic planning, existing health & wellness committees, and/or student support teams. Not Interested
Improve coordination of existing supports and services for students and families.	Improve coordination of existing supports and services for students and families. Very Interested	Improve coordination of existing supports and services for students and families. Interested	Improve coordination of existing supports and services for students and families. Not Interested
Connect with community agencies, county task forces, education service districts, and state supports to obtain additional resources, supports, and services.	Connect with community agencies, county task forces, education service districts, and state supports to obtain additional resources, supports, and services. Very Interested	Connect with community agencies, county task forces, education service districts, and state supports to obtain additional resources, supports, and services. Interested	Connect with community agencies, county task forces, education service districts, and state supports to obtain additional resources, supports, and services. Not Interested
Build/expand upon a system where teachers and staff can refer students and families who needs services or supports.	Build/expand upon a system where teachers and staff can refer students and families who needs services or supports. Very Interested	Build/expand upon a system where teachers and staff can refer students and families who needs services or supports. Interested	Build/expand upon a system where teachers and staff can refer students and families who needs services or supports. Not Interested
Develop a K-12 standards-based, skills-focused health education curriculum.	Develop a K-12 standards-based, skills-focused health education curriculum. Very Interested	Develop a K-12 standards-based, skills-focused health education curriculum. Interested	Develop a K-12 standards-based, skills-focused health education curriculum. Not Interested
Develop a K-12 standards-based physical education curriculum	Develop a K-12 standards-based physical education curriculum Very Interested	Develop a K-12 standards-based physical education curriculum Interested	Develop a K-12 standards-based physical education curriculum Not Interested
Create a trauma-sensitive culture that supports all students’ socially, emotionally and academically.	Create a trauma-sensitive culture that supports all students’ socially, emotionally and academically. Very Interested	Create a trauma-sensitive culture that supports all students’ socially, emotionally and academically. Interested	Create a trauma-sensitive culture that supports all students’ socially, emotionally and academically. Not Interested
Provide effective self-care strategies and resources for our educators.	Provide effective self-care strategies and resources for our educators. Very Interested	Provide effective self-care strategies and resources for our educators. Interested	Provide effective self-care strategies and resources for our educators. Not Interested
Collect and analyze data to determine student, family, and community needs.	Collect and analyze data to determine student, family, and community needs. Very Interested	Collect and analyze data to determine student, family, and community needs. Interested	Collect and analyze data to determine student, family, and community needs. Not Interested
Develop family engagement activities.	Develop family engagement activities. Very Interested	Develop family engagement activities. Interested	Develop family engagement activities. Not Interested
Develop/expand upon a multi-tiered system of prevention programs and social emotional student supports that most effectively aligns with our current system	Develop/expand upon a multi-tiered system of prevention programs and social emotional student supports that most effectively aligns with our current system Very Interested	Develop/expand upon a multi-tiered system of prevention programs and social emotional student supports that most effectively aligns with our current system Interested	Develop/expand upon a multi-tiered system of prevention programs and social emotional student supports that most effectively aligns with our current system Not Interested
Develop lead, and sustain Whole Child/School Health Councils	Develop lead, and sustain Whole Child/School Health Councils Very Interested	Develop lead, and sustain Whole Child/School Health Councils Interested	Develop lead, and sustain Whole Child/School Health Councils Not Interested
Develop skills of the Whole Child/School Health Coordinator	Develop skills of the Whole Child/School Health Coordinator Very Interested	Develop skills of the Whole Child/School Health Coordinator Interested	Develop skills of the Whole Child/School Health Coordinator Not Interested

Question Title

* 2. Please click on any of the following topics that drive your reasons to engage in the Whole School, Whole Community, Whole Child (WSCC) Approach? (Select all that apply)

Substance use prevention

Comprehensive school mental health including suicide prevention

Trauma-informed schools

School-based health centers

Nutrition and healthy eating

Social-Emotional Learning

PBIS

Staff Wellness & Self-Care

Covid-19

Healthy Relationships

Sexual Health

Violence Prevention

Other (please specify)

Question Title

* 3. Please rate your current level of knowledge about the following terms associated with the Whole School, Whole Community, Whole Child

	Very Knowledgeable	Somewhat Knowledgeable	Not very knowledgeable/New Concept
Tenets of the WSCC (health, safe, engaged, supported, challenged)	Tenets of the WSCC (health, safe, engaged, supported, challenged) Very Knowledgeable	Tenets of the WSCC (health, safe, engaged, supported, challenged) Somewhat Knowledgeable	Tenets of the WSCC (health, safe, engaged, supported, challenged) Not very knowledgeable/New Concept
Components of WSCC (e.g. health education, health services)	Components of WSCC (e.g. health education, health services) Very Knowledgeable	Components of WSCC (e.g. health education, health services) Somewhat Knowledgeable	Components of WSCC (e.g. health education, health services) Not very knowledgeable/New Concept
Policies, programs, and practices	Policies, programs, and practices Very Knowledgeable	Policies, programs, and practices Somewhat Knowledgeable	Policies, programs, and practices Not very knowledgeable/New Concept
Community Partnerships	Community Partnerships Very Knowledgeable	Community Partnerships Somewhat Knowledgeable	Community Partnerships Not very knowledgeable/New Concept
Health Services	Health Services Very Knowledgeable	Health Services Somewhat Knowledgeable	Health Services Not very knowledgeable/New Concept
Behavioral/Mental Health Services	Behavioral/Mental Health Services Very Knowledgeable	Behavioral/Mental Health Services Somewhat Knowledgeable	Behavioral/Mental Health Services Not very knowledgeable/New Concept
Family Engagement	Family Engagement Very Knowledgeable	Family Engagement Somewhat Knowledgeable	Family Engagement Not very knowledgeable/New Concept
Equity and Diversity	Equity and Diversity Very Knowledgeable	Equity and Diversity Somewhat Knowledgeable	Equity and Diversity Not very knowledgeable/New Concept
Whole School Approach	Whole School Approach Very Knowledgeable	Whole School Approach Somewhat Knowledgeable	Whole School Approach Not very knowledgeable/New Concept
Systems-Thinking	Systems-Thinking Very Knowledgeable	Systems-Thinking Somewhat Knowledgeable	Systems-Thinking Not very knowledgeable/New Concept

Question Title

* 4. Please rate how you perceive the current level of support for the WSCC approach from each stakeholder group.

	Very Supportive	Somewhat Supportive	Not Supportive/New Concept
Administrator	Administrator Very Supportive	Administrator Somewhat Supportive	Administrator Not Supportive/New Concept
Community Partners	Community Partners Very Supportive	Community Partners Somewhat Supportive	Community Partners Not Supportive/New Concept
Staff	Staff Very Supportive	Staff Somewhat Supportive	Staff Not Supportive/New Concept
Community Stakeholders	Community Stakeholders Very Supportive	Community Stakeholders Somewhat Supportive	Community Stakeholders Not Supportive/New Concept
Families	Families Very Supportive	Families Somewhat Supportive	Families Not Supportive/New Concept

Question Title

* 5. We have incorporated WSCC or a student health goal within our strategic plan.

Yes

Somewhat

Other (please specify)

Question Title

* 6. We have a team that meets regularly to discuss the health and well-being of our students.

Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

Question Title

* 7. We have conducted a needs assessment and/or collected school or local health data.

Yes

Question Title

* 8. Our health education curriculum has been updated within the last 5 years.

Yes

Maybe

Other (please specify)

Question Title

* 9. Our physical education has been updated within the last 5 years.

Yes

Maybe

Other (please specify)

Question Title

* 10. We have a referral system where staff can reach out and refer students and/or families who need additional supports/services for health and wellness.

Yes

Maybe

Other (please specify)

Question Title

* 11. We have funding or resources to support our Whole Child goals/initiatives.

Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

Question Title

* 12. We have a leader or "Whole Child Liaison/Coordinator" for the district's whole child efforts.

Yes

Maybe

Other (please specify)

Question Title

* 13. Tell us a little more about your goals for the whole child work or anything additional information to help us support your efforts.

Question Title

* 14. What is your position?

Adminstrator (Superintendent, Principal, Assistant Principal, Curriculum Director)

Classroom Teacher

Health Education Teacher

Physical Education Teacher

Prevention Specialist

School Counselor

School Nurse

School Social Worker

Student Services Coordinator

School Psychologist

Community Health Services Provider

Community Behavioral Health Service Provider

Blaze Questionnaire

Tell us more about your journey so far for student success!

Question Title

* 1. Please check the appropriate column for your level of interest for each of the items.

Question Title

* 2. Please click on any of the following topics that drive your reasons to engage in the Whole School, Whole Community, Whole Child (WSCC) Approach? (Select all that apply)

Question Title

* 3. Please rate your current level of knowledge about the following terms associated with the Whole School, Whole Community, Whole Child

Question Title

* 4. Please rate how you perceive the current level of support for the WSCC approach from each stakeholder group.

Question Title

* 5. We have incorporated WSCC or a student health goal within our strategic plan.

Question Title

* 6. We have a team that meets regularly to discuss the health and well-being of our students.

Question Title

* 7. We have conducted a needs assessment and/or collected school or local health data.

Question Title

* 8. Our health education curriculum has been updated within the last 5 years.

Question Title

* 9. Our physical education has been updated within the last 5 years.

Question Title

* 10. We have a referral system where staff can reach out and refer students and/or families who need additional supports/services for health and wellness.

Question Title

* 11. We have funding or resources to support our Whole Child goals/initiatives.

Question Title

* 12. We have a leader or "Whole Child Liaison/Coordinator" for the district's whole child efforts.

Question Title

* 13. Tell us a little more about your goals for the whole child work or anything additional information to help us support your efforts.

Question Title

* 14. What is your position?

Question Title

* 15. Please list your school district, city and state.

Question Title

* 16. Please add your email address.