Student Intake /Needs Assessment Survey/English Question Title * 1. Student Grade Level Question Title * 2. What impact has the pandemic had on the family? Illness Death Economic Other (please specify) Question Title * 3. Are the parents/guardians employed? Yes No Question Title * 4. What educational activities has the student been engaged in since school was last in session? Question Title * 5. Harvey Public School will require that parents self-certify that their children are symptom-free each day prior to sending them to school. Symptoms include fever, cough, shortness of breath, difficulty breathing, chills, fatigue, muscle and body aches, headache, sore throat, loss of taste or smell, congestion or runny nose, nausea, vomiting, and diarrhea. Will you be willing to provide this information to the school on a daily basis? Yes No Question Title * 6. The new state guidance has recommended schools return to face-to-face instruction. Are you in agreement with this decision? Yes No Question Title * 7. Do you intend to allow your child(ren) to return to Harvey 152 in the fall? Yes No Unsure Question Title * 8. The State also gives Districts some flexibility in returning to school. If allowed, how would you prefer for students to return? Virtual Learning Full Face to Face Learning Hybrid Model (Face to Face Learning and Virtual Learning) Other (please specify) Question Title * 9. Which of the following improvements would you like to see if your school has to return to Virtual Learning? Provide better communication Provide more resources in a language that I understand Provide more meaningful assignments Provide fewer assignments Provide more technology (chromebook, hot spot) Provide more technology assistance Provide more guidance to me on student learning Question Title * 10. How concerned are you about your child's social or emotional well-being during Virtual Learning? Concerned Very Concerned Extremely Concerned Not Concerned Other (please specify) Done