* 1. Your child(ren) are in which grades (mark all that apply):

* 2. Which of the following Social/Emotional Health issues do you consider the biggest challenges to student success at Burgin Schools (mark three answers):

* 3. Which of the following Physical Health & Safety issues do you consider the biggest challenges to student success at Burgin Schools (mark three answers):

* 4. Which of the following Educational issues do you consider the biggest challenges to student success at Burgin Schools (mark three answers):

* 5. Which of the following Family issues do you consider the biggest challenges to student success at Burgin Schools (mark three answers):

* 6. Which of the following Employability/Post-Secondary Educational issues do you consider the biggest challenges to student success at Burgin Schools (mark three answers):

* 7. The Burgin Family Connections FRYSC Coordinator is willing and available to discuss students' and families' needs.

* 8. The Burgin Family Connections FRYSC Coordinator addresses requests/needs in a timely manner.

* 9. The Burgin Family Connections FRYSC communicates well with students, families and staff.

* 10. The Burgin Family Connections FRYSC Coordinator collaborates with teachers, families, staff, community and other programs or agencies to meet needs.

* 11. The Burgin Family Connections FRYSC Coordinator is visible, accessible and pleasant with students and families.

* 12. The Burgin Family Connections FRYSC Coordinator is willing to help with student, teacher and family issues.

* 13. The Burgin Family Connections FRYSC Coordinator is an important and integral part of the school staff.

* 14. The Burgin Family Connections FRYSC Coordinator is an important and integral part of the community.

* 15. Burgin Family Connections is removing barriers to student success.

* 16. I would refer a friend or family member to Burgin Family Connections.

* 17. My family has received services from Burgin Family Connections.

* 18. If yes, how satisfied were you with those services?

* 19. I am familiar with the services offered by Burgin Family Connections.

* 20. List the average number of minutes you spend reading with your child(ren) each week.

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