Screen Reader Mode Icon
Hello Breakthrough Families! Please fill out this survey to help us determine how we can best support you in the coming weeks. Your responses will help us connect you with the right resources and share the most relevant information. The survey has 23 very short questions and will take approximately 4 minutes to complete. Please reach out to us if you have any questions.  

Question Title

* 1. Parent/Guardian Name

Question Title

* 2. Student Name

Question Title

* 3. Student Current Grade

Question Title

* 4. Student Current School

Question Title

* 5. Breakthrough Campus

Question Title

* 6. Do you live with someone who is considered most vulnerable for COVID-19? This includes adults over the age of 60 or anyone who is immunocompromised (people with a reduced ability to fight infections or disease).

Question Title

* 7. Has anyone in your household been diagnosed with COVID-19?

Question Title

* 8. Does anyone in your household have symptoms of COVID-19 (fever, cough, or trouble breathing)?

Question Title

* 9. Do you know how to get medical support if needed?

Question Title

* 10. Are you concerned about having enough food and/or cleaning supplies at home?

Question Title

* 11. Are you aware of the food distribution centers in your city?

Question Title

* 12. Are you experiencing or do you expect a loss of income during the shelter in place and social distancing time period?

Question Title

* 13. Are you aware of any emergency grant programs in your city?

Question Title

* 14. Do you have reliable internet access at home?

Question Title

* 15. Are you aware of free internet options? 

Question Title

* 16. Do you have a working computer at home (not including one provided by your child's school)?

Question Title

* 17. Did you receive a chrome book from your child's school?

Question Title

* 18. Do you still need a computer? 

Question Title

* 19. Have you received schoolwork from your child's teachers?

Question Title

* 20. If yes, did you receive a packet or online assignments?

Question Title

* 21. For families with a current Breakthrough senior, do you need support with asking the college you plan to go to for a deposit extension?

Question Title

* 22. Have you been receiving Breakthrough's weekly email updates?

Question Title

* 23. If you have not been receiving Breakthrough's weekly email updates, please share your email address below.

Question Title

* 24. Is there anything Breakthrough can do to support you during this time?

0 of 24 answered
 

T