Student and Family Needs During School Closure

This survey is for families who anticipate they will need services and support from the school and local community during the closure.

If you are a family who can offer assistance please contact Mrs. Rian.

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* 1. Please enter your contact information below.

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 2. Do you work in the health care field, or are a first responder, and need support for childcare?

No

Yes (please specify)

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* 3. Do you anticipate needing assistance in obtaining food for meals?

No

Yes (please specify)

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* 4. Do you anticipate needing assistance in filling prescriptions or affording medicine?

No

Yes (please specify)

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* 5. As teachers move to online-learning, do you need assistance to provide a device for your child to use?

No

Yes (please specify)

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* 6. Does your family have barriers to accessing the internet?

No

Yes (please specify)

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* 7. Do you have any other needs?