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* 1. Are you… (select all that apply)

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* 2. Name of your community

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* 3. Which school does your child(ren) attend?

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* 5. If other, please specify:

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* 6. Share your ideas or current enriching Dine Culture and Language experiential learning activities our student benefits or will benefit from:

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* 7. Are you interested in learning more about JOM activities at KUSD?

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* 8. To share news about the Districts JOM Program, what is the best way to contact you? Select at least 1 and no more than 6.

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* 9. Have you applied for assistance under the Johnson O'Malley Program?

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* 10. What assistance did you requested for under the Johnson O'Malley Program?

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* 11. Please provide us your feedback or questions about the Johnson O'Malley Program?

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