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Please take the time to complete this quick survey.  All your answers will be kept confidential.  The information you provide may help Wrangell Public Schools qualify for federal funding to provide more education services to our students.  This program services children of migratory families who participate in fishing, logging, and/or agriculture industries.

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* 1. Name of Student

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* 2. Contact Phone Number

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* 3. Within the past three years, has anyone in your family engaged in the following activities? If so, please check the appropriate categories.

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* 4. Who was/were the individual(s) that engaged in the activity checked above?

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* 5. Location of Migrant Activity:

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* 6. Type of Catch (check all that apply)

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* 7. Type of Gear/Activity (check all that apply)

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