1. Default Section

* 1. Would your child participate in a program that provide assistance with career goals?

* 2. Is your child currently having problems with another individual in school?

* 3. Do you think your child require or would like a mediator when a issue with a teacher or a fellow student arise?

* 4. Would you allow your child or youth to participate with volunteer work in your community?

* 5. Are you a teacher,education provider or volunteer that would be in participated free time in this project?

* 6. How many children live at you home?

* 7. What are your children are range? (select all that apply)

* 8. Please give as much information as possible in order to contact for further support or future question.

* 9. How much do you think this program would impact the following.

  Very Little Some Help Very Much Great Impact N/A
Family
Child Futre Career
Community
Educational Goals

* 10. Do you have any suggestion, comments or questions?

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