DCHS YSC Parent Survey Fall 2011

1. DCHS Youth Services Center Parent Survey

Please take 5 minutes to complete this very important survey. By completing this survey the DCHS YSC will be able to better serve students and families as well as obtain funding for programs and services to meet the needs of our families. All information will be confidential. Thank you for your time!

Question Title

* 1. My child(ren) live(s) with:

Both Parents

Single Parent

Parent/Stepparent

Grandparents

Legal Guardian

Question Title

* 2. I have the following education:

Less than High School

High School or GED

Some College/Vocational School

College

Post College

Question Title

* 3. Does your child receive:

Private Health Insurance

K-Chip

Medical Card

No health insurance

Question Title

* 4. What do you see as an important need(s) for East FRC students?

Extra Support for Basic Needs (clothing, school supplies, etc.)

Health Services (medical, medication, dental, vision, etc.)

Mental Health (Support Referral

Attendance - Truancy

Tutoring/ Homework Help

Alcohol/ Drug Abuse

Risky Behaviors

Online Risks - Identity Theft, Bullying, Predators

Other (please specify)