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* 1. Please select the grade level of your child(ren).

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* 2.

Do you feel your child(ren) needs additional help in any of the following areas?  Check all that apply.

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* 3. When would be the best time for your child(ren) to receive academic services?

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* 4. What would you say are your main concerns right now?

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* 5. Which cultural area(s) would your child(ren) benefit? Please rank each area in order of importance to you and your family (1 is most important - 5 is least important). 

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* 6.

When thinking about cultural activities, what suggestions do you have?

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* 7.

OPTIONAL: If you would like to be entered into a drawing for a $25 Meijer gift card, please enter your name and a way to contact you (phone number or email).

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