2021-22 PreK-12 Program Survey

Household Information

Question Title

* 1. Primary Contact Information

Parent Name (First and Last) *

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Phone Number *

Question Title

* 2. Has your address changed from last year

Yes

No

Question Title

* 3. Relationship to student(s)

Mother

Father

Other (please specify)

Question Title

* 4. Does your household qualify for free or reduced meals at school?

Yes

No

Question Title

* 5. How many Gun Lake Tribal students ages 3-18 are in the household?

Question Title

* 6. Are there any children (3-18 yrs) in the household who are not Gun Lake Citizens?

Yes

No