* 1. Please indicate your response to each statement on a scale of Strongly Disagree to Strongly Agree If a statement does not apply to your situation, indicate N/A.

  N/A Strongly Disagree Disagree Neutral Agree Strongly Agree
If I have left a message for one of my child’s teachers this year, I have received a response within 24 hours.
If I have left a message for an administrator this year, I have received a response within 24 hours.
I have received a positive contact (e-mail, note, phone call) regarding my child this year.
I prefer using email when communicating with my child’s school.
If I have contacted the school with a concern this year, it has been resolved to my satisfaction.
At least one of my child’s teachers has initiated contact with me this year regarding his/her academic progress.
At least one of my child’s teachers has initiated contact with me this year regarding his/her behavior.

* 2. Please indicate your response to each statement on a scale of Strongly Disagree to Strongly Agree If a statement does not apply to your situation, indicate N/A.

  N/A Strongly Disagree Disagree Neutral Agree Strongly Agree
If my child has had problems learning, he/she has received additional instruction before or after school.
If my child has had problems learning, he/she has received additional small group or individual instruction during school.
If my child has had problems learning, his/her teacher has contacted me through directly (e-mail, note, phone call).
If my child is eligible for special education services, he/she is receiving the instruction he/she needs.
If my child is eligible for gifted and talented services, he/she is receiving the instruction he/she needs.
If I have requested, my child’s teacher has provided instructional strategies for me to use with my child at home.
Daily instruction is designed in a way in which my child learns best.

* 3. Please indicate your response to each statement on a scale of Strongly Disagree to Strongly Agree If a statement does not apply to your situation, indicate N/A.

  N/A Strongly Disagree Disagree Neutral Agree Strongly Agree
I am aware of the homework policy at my child’s school.
I am aware of the attendance policy at my child’s school.
I am aware of the grading scale used at my child’s school.
I am aware of the dress code policy at my child’s school.
I am aware of the extra-curricular eligibility requirements at my child’s school.

* 4. Please indicate your response to each statement on a scale of Strongly Disagree to Strongly Agree If a statement does not apply to your situation, indicate N/A.

  N/A Strongly Disagree Disagree Neutral Agree Strongly Agree
I have been informed of the school emergency procedures for my child.
If there is a community emergency, I know where and when to pick up my child.
My child has a contact at school if he/she has a problem.
This year, my child has asked not to go to school on at least one occasion because he/she is afraid.
If I have expressed a concern for my child’s safety, school personnel have listened.
My child has been bullied at school this year.
My child has an adult at school he/she trusts.

* 5. Please indicate your response to each statement on a scale of Strongly Disagree to Strongly Agree If a statement does not apply to your situation, indicate N/A.

  N/A Strongly Disagree Disagree Neutral Agree Strongly Agree
I view staff at my child’s school as professionals.
I believe the staff at my child’s school treat all students equally.
I feel welcome in my child’s school.
I believe the staff at my child’s school genuinely care about his/her well-being.
I feel that the staff at my child’s school respect me as a parent/guardian.

* 6. Thank you for taking time to provide us feedback regarding our schools. Your input is important to us. Feel free to share additional comments in the space below.

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