20-21 SSD Homebound Parent Survey

This survey is for students and families of students who have received Homebound Services. Please take a few moments to rate your satisfaction with your homebound experience. We use your input to evaluate our program which helps us work towards improving our services to students and families. Thanks for your time!

	Very satisfied	Somewhat satisfied	Average	Somewhat dissatisfied	Very dissatisfied	NOT APPLICABLE
a) Helpfulness of school staff when initiating the Homebound Application	a) Helpfulness of school staff when initiating the Homebound Application Very satisfied	a) Helpfulness of school staff when initiating the Homebound Application Somewhat satisfied	a) Helpfulness of school staff when initiating the Homebound Application Average	a) Helpfulness of school staff when initiating the Homebound Application Somewhat dissatisfied	a) Helpfulness of school staff when initiating the Homebound Application Very dissatisfied	a) Helpfulness of school staff when initiating the Homebound Application NOT APPLICABLE
b) Clear directions for required paperwork to complete the Homebound application	b) Clear directions for required paperwork to complete the Homebound application Very satisfied	b) Clear directions for required paperwork to complete the Homebound application Somewhat satisfied	b) Clear directions for required paperwork to complete the Homebound application Average	b) Clear directions for required paperwork to complete the Homebound application Somewhat dissatisfied	b) Clear directions for required paperwork to complete the Homebound application Very dissatisfied	b) Clear directions for required paperwork to complete the Homebound application NOT APPLICABLE
c) Cooperation of school staff when supplying school assignments and materials	c) Cooperation of school staff when supplying school assignments and materials Very satisfied	c) Cooperation of school staff when supplying school assignments and materials Somewhat satisfied	c) Cooperation of school staff when supplying school assignments and materials Average	c) Cooperation of school staff when supplying school assignments and materials Somewhat dissatisfied	c) Cooperation of school staff when supplying school assignments and materials Very dissatisfied	c) Cooperation of school staff when supplying school assignments and materials NOT APPLICABLE
d) Appropriate amount of school work assigned to student while receiving Homebound Services	d) Appropriate amount of school work assigned to student while receiving Homebound Services Very satisfied	d) Appropriate amount of school work assigned to student while receiving Homebound Services Somewhat satisfied	d) Appropriate amount of school work assigned to student while receiving Homebound Services Average	d) Appropriate amount of school work assigned to student while receiving Homebound Services Somewhat dissatisfied	d) Appropriate amount of school work assigned to student while receiving Homebound Services Very dissatisfied	d) Appropriate amount of school work assigned to student while receiving Homebound Services NOT APPLICABLE
e) Level of support received from the school when the student returned to school	e) Level of support received from the school when the student returned to school Very satisfied	e) Level of support received from the school when the student returned to school Somewhat satisfied	e) Level of support received from the school when the student returned to school Average	e) Level of support received from the school when the student returned to school Somewhat dissatisfied	e) Level of support received from the school when the student returned to school Very dissatisfied	e) Level of support received from the school when the student returned to school NOT APPLICABLE
f) Promptness of initial homebound teacher contact	f) Promptness of initial homebound teacher contact Very satisfied	f) Promptness of initial homebound teacher contact Somewhat satisfied	f) Promptness of initial homebound teacher contact Average	f) Promptness of initial homebound teacher contact Somewhat dissatisfied	f) Promptness of initial homebound teacher contact Very dissatisfied	f) Promptness of initial homebound teacher contact NOT APPLICABLE
g) Timeliness of start of homebound services	g) Timeliness of start of homebound services Very satisfied	g) Timeliness of start of homebound services Somewhat satisfied	g) Timeliness of start of homebound services Average	g) Timeliness of start of homebound services Somewhat dissatisfied	g) Timeliness of start of homebound services Very dissatisfied	g) Timeliness of start of homebound services NOT APPLICABLE
h) Flexibility of homebound teacher's schedule	h) Flexibility of homebound teacher's schedule Very satisfied	h) Flexibility of homebound teacher's schedule Somewhat satisfied	h) Flexibility of homebound teacher's schedule Average	h) Flexibility of homebound teacher's schedule Somewhat dissatisfied	h) Flexibility of homebound teacher's schedule Very dissatisfied	h) Flexibility of homebound teacher's schedule NOT APPLICABLE
i) Communication with homebound teacher	i) Communication with homebound teacher Very satisfied	i) Communication with homebound teacher Somewhat satisfied	i) Communication with homebound teacher Average	i) Communication with homebound teacher Somewhat dissatisfied	i) Communication with homebound teacher Very dissatisfied	i) Communication with homebound teacher NOT APPLICABLE
j) Quality of instruction given by homebound teacher	j) Quality of instruction given by homebound teacher Very satisfied	j) Quality of instruction given by homebound teacher Somewhat satisfied	j) Quality of instruction given by homebound teacher Average	j) Quality of instruction given by homebound teacher Somewhat dissatisfied	j) Quality of instruction given by homebound teacher Very dissatisfied	j) Quality of instruction given by homebound teacher NOT APPLICABLE
k) Received monthly Progress Report from homebound teacher.	k) Received monthly Progress Report from homebound teacher. Very satisfied	k) Received monthly Progress Report from homebound teacher. Somewhat satisfied	k) Received monthly Progress Report from homebound teacher. Average	k) Received monthly Progress Report from homebound teacher. Somewhat dissatisfied	k) Received monthly Progress Report from homebound teacher. Very dissatisfied	k) Received monthly Progress Report from homebound teacher. NOT APPLICABLE
l) Level of support and cooperation received from the Homebound Office staff.	l) Level of support and cooperation received from the Homebound Office staff. Very satisfied	l) Level of support and cooperation received from the Homebound Office staff. Somewhat satisfied	l) Level of support and cooperation received from the Homebound Office staff. Average	l) Level of support and cooperation received from the Homebound Office staff. Somewhat dissatisfied	l) Level of support and cooperation received from the Homebound Office staff. Very dissatisfied	l) Level of support and cooperation received from the Homebound Office staff. NOT APPLICABLE

Very satisfied

Somewhat satisfied

Average

Somewhat dissatisfied

Very dissatisfied

NOT APPLICABLE

a) Helpfulness of school staff when initiating the Homebound Application

a) Helpfulness of school staff when initiating the Homebound Application Very satisfied

a) Helpfulness of school staff when initiating the Homebound Application Somewhat satisfied

a) Helpfulness of school staff when initiating the Homebound Application Average

a) Helpfulness of school staff when initiating the Homebound Application Somewhat dissatisfied

a) Helpfulness of school staff when initiating the Homebound Application Very dissatisfied

a) Helpfulness of school staff when initiating the Homebound Application NOT APPLICABLE

b) Clear directions for required paperwork to complete the Homebound application

b) Clear directions for required paperwork to complete the Homebound application Very satisfied

b) Clear directions for required paperwork to complete the Homebound application Somewhat satisfied

b) Clear directions for required paperwork to complete the Homebound application Average

b) Clear directions for required paperwork to complete the Homebound application Somewhat dissatisfied

b) Clear directions for required paperwork to complete the Homebound application Very dissatisfied

b) Clear directions for required paperwork to complete the Homebound application NOT APPLICABLE

c) Cooperation of school staff when supplying school assignments and materials

c) Cooperation of school staff when supplying school assignments and materials Very satisfied

c) Cooperation of school staff when supplying school assignments and materials Somewhat satisfied

c) Cooperation of school staff when supplying school assignments and materials Average

c) Cooperation of school staff when supplying school assignments and materials Somewhat dissatisfied

c) Cooperation of school staff when supplying school assignments and materials Very dissatisfied

c) Cooperation of school staff when supplying school assignments and materials NOT APPLICABLE

d) Appropriate amount of school work assigned to student while receiving Homebound Services

d) Appropriate amount of school work assigned to student while receiving Homebound Services Very satisfied

d) Appropriate amount of school work assigned to student while receiving Homebound Services Somewhat satisfied

d) Appropriate amount of school work assigned to student while receiving Homebound Services Average

d) Appropriate amount of school work assigned to student while receiving Homebound Services Somewhat dissatisfied

d) Appropriate amount of school work assigned to student while receiving Homebound Services Very dissatisfied

d) Appropriate amount of school work assigned to student while receiving Homebound Services NOT APPLICABLE

e) Level of support received from the school when the student returned to school

e) Level of support received from the school when the student returned to school Very satisfied

e) Level of support received from the school when the student returned to school Somewhat satisfied

e) Level of support received from the school when the student returned to school Average

e) Level of support received from the school when the student returned to school Somewhat dissatisfied

e) Level of support received from the school when the student returned to school Very dissatisfied

e) Level of support received from the school when the student returned to school NOT APPLICABLE

f) Promptness of initial homebound teacher contact

f) Promptness of initial homebound teacher contact Very satisfied

f) Promptness of initial homebound teacher contact Somewhat satisfied

f) Promptness of initial homebound teacher contact Average

f) Promptness of initial homebound teacher contact Somewhat dissatisfied

f) Promptness of initial homebound teacher contact Very dissatisfied

f) Promptness of initial homebound teacher contact NOT APPLICABLE

g) Timeliness of start of homebound services

g) Timeliness of start of homebound services Very satisfied

g) Timeliness of start of homebound services Somewhat satisfied

g) Timeliness of start of homebound services Average

g) Timeliness of start of homebound services Somewhat dissatisfied

g) Timeliness of start of homebound services Very dissatisfied

g) Timeliness of start of homebound services NOT APPLICABLE

h) Flexibility of homebound teacher's schedule

h) Flexibility of homebound teacher's schedule Very satisfied

h) Flexibility of homebound teacher's schedule Somewhat satisfied

h) Flexibility of homebound teacher's schedule Average

h) Flexibility of homebound teacher's schedule Somewhat dissatisfied

h) Flexibility of homebound teacher's schedule Very dissatisfied

h) Flexibility of homebound teacher's schedule NOT APPLICABLE

i) Communication with homebound teacher

i) Communication with homebound teacher Very satisfied

i) Communication with homebound teacher Somewhat satisfied

i) Communication with homebound teacher Average

i) Communication with homebound teacher Somewhat dissatisfied

i) Communication with homebound teacher Very dissatisfied

i) Communication with homebound teacher NOT APPLICABLE

j) Quality of instruction given by homebound teacher

j) Quality of instruction given by homebound teacher Very satisfied

j) Quality of instruction given by homebound teacher Somewhat satisfied

j) Quality of instruction given by homebound teacher Average

j) Quality of instruction given by homebound teacher Somewhat dissatisfied

j) Quality of instruction given by homebound teacher Very dissatisfied

j) Quality of instruction given by homebound teacher NOT APPLICABLE

k) Received monthly Progress Report from homebound teacher.

k) Received monthly Progress Report from homebound teacher. Very satisfied

k) Received monthly Progress Report from homebound teacher. Somewhat satisfied

k) Received monthly Progress Report from homebound teacher. Average

k) Received monthly Progress Report from homebound teacher. Somewhat dissatisfied

k) Received monthly Progress Report from homebound teacher. Very dissatisfied

k) Received monthly Progress Report from homebound teacher. NOT APPLICABLE

l) Level of support and cooperation received from the Homebound Office staff.

l) Level of support and cooperation received from the Homebound Office staff. Very satisfied

l) Level of support and cooperation received from the Homebound Office staff. Somewhat satisfied

l) Level of support and cooperation received from the Homebound Office staff. Average

l) Level of support and cooperation received from the Homebound Office staff. Somewhat dissatisfied

l) Level of support and cooperation received from the Homebound Office staff. Very dissatisfied

l) Level of support and cooperation received from the Homebound Office staff. NOT APPLICABLE

20-21 SSD Homebound Parent Survey

SSD Homebound Services Survey

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* 1. Homebound Student's Name:

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* 2. Homebound Student's School District?

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* 3. Homebound Student's School

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* 4. Homebound Teacher's Name(s)

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* 5. Name of person completing survey (Optional):

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* 6. Please rate your level of satisfaction with the Homebound Process and Instruction:

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* 7. Please note things you LIKED about homebound:

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* 8. Please note things you DID NOT LIKE about homebound:

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* 9. Please note any suggestions you have for improvement: