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* 1. What grade is your child or children in? Mark all that apply.

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* 2. How much do you agree with the following statement? Parent activities are scheduled at times I can attend.

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* 3. How much do you agree with the following statement? I know how to contact my child’s teacher(s).

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* 4. How much do you agree with the following statement? I am treated with respect in my child’s school.

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* 5. How much do you agree with the following statement? I am satisfied with the response I get when I contact my child’s school with questions or concerns.

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* 6. How much do you agree with the following statement? The principal or school leader is accessible to me.

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* 7. How much do you agree with the following statement? I feel welcome in my child’s school.

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* 8. How often do the following things happen at your child’s school? Adults at my child’s school treat my child with respect.

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* 9. How often do the following things happen at your child’s school? My child is bullied at school.

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* 10. How often do the following things happen at your child’s school? My child is treated badly at school because of his/her race, ethnicity, or background.

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* 11. How often do the following things happen at your child’s school? My child is treated badly at school because of his/her religion.

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* 12. How often do the following things happen at your child’s school? My child is treated badly at school because of his/her gender identity.

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* 13. How often do the following things happen at your child’s school? My child is treated badly at school because of his/her sexual orientation.

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* 14. How often do the following things happen at your child’s school? My child is treated badly at school because he/she has a disability.

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* 15. How often do the following things happen at your child’s school? My child feels safe going to and from school.

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* 16. How often do the following things happen at your child’s school? My child feels safe at school.

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* 17. How often do the following things happen at your child’s school? My child’s school is clean.

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* 18. How much do you agree with the following statement? My child’s school communicates with me in a language I understand.

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* 19. How much do you agree with the following statement? Documents sent home from my child’s school are in the language I selected.

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* 20. How much do you agree with the following statement? My child’s school communicates with me in a manner that is clear and timely.

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* 21. How much do you agree with the following statement? My child’s school gives me information about how I can help my child be successful in school.

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* 22. How much do you agree with the following statement? My child’s school gives me information about what my child is expected to learn.

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* 23. How much do you agree with the following statement? My child’s school does a good job of letting me know about meetings and special school events.

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* 24. How much do you agree with the following statement? My child’s school does a good job letting me know about school rules and policies.

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* 25. How much do you agree with the following statement? My child’s school invites me to be included in decisions that affect my child’s education.

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* 26. How much do you agree with the following statement? My school values my feedback.

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* 27. How often does someone from your child’s school do the following? Contact me about my child’s achievements and successes.

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* 28. How often does someone from your child’s school do the following? Provide me with regular feedback about my child’s progress.

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* 29. How often does someone from your child’s school do the following? Send emails, newsletters, or notes home telling me what my child is learning in school.

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* 30. How often does someone from your child’s school do the following? Contact me if my child is struggling academically.

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* 31. How often does someone from your child’s school do the following? Contact me if my child misbehaves or breaks school rules.

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* 32. How often does someone from your child’s school do the following? Provide me with information about how to help my child with homework.

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* 33. How much do you agree with the following statement? My child’s school has high expectations for my child’s learning.

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* 34. How much do you agree with the following statement? My child’s school meets the specific non-academic needs of my child (for example, behavioral and social-emotional needs).

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* 35. How much do you agree with the following statement? Teachers at my child’s school encourage my child to work hard.

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* 36. How much do you agree with the following statement? Teachers at my child’s school give helpful comments on homework, classwork, and tests.

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* 37. How much do you agree with the following statement? I am pleased with the quality of education my child’s school is providing for my child.

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* 38. This year, how much of a challenge is this thing in making sure your child attends school every day: Transportation provided by the school district (school bus, van)

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* 39. This year, how much of a challenge is this thing in making sure your child attends school every day: Family responsibilities (for example, taking care of a family member, must work)

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* 40. This year, how much of a challenge is this thing in making sure your child attends school every day: Unsafe walking route to school

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* 41. This year, how much of a challenge is this thing in making sure your child attends school every day: My child does not feel safe at school

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* 42. This year, how much of a challenge is this thing in making sure your child attends school every day: Chronic or ongoing medical issues

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* 43. This year, how much of a challenge is this thing in making sure your child attends school every day: Out-of-School Suspensions

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* 44. This year, how much of a challenge is this thing in making sure your child attends school every day: Lack of interest in classes

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* 45. This year, how much of a challenge is this thing in making sure your child attends school every day: Lack of meaningful relationships with adults in school

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* 46. This year, how much of a challenge is this thing in making sure your child attends school every day: Housing instability

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* 47. This year, how much of a challenge is this thing in making sure your child attends school every day: Involvement in child welfare system

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* 48. This year, how much of a challenge is this thing in making sure your child attends school every day: Peer pressure

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* 49. If you have additional feedback you would like to provide about your child’s school, please write it in the space below.

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