2018 Youth Services Center Parent/Guardian Survey

Our Youth Service Centers serve students at the Middle and High Schools. We offer a unique blend of programs and services to serve the special needs of our students and family client populations. The goal is to meet the needs of all students and their families served by our centers as a means to enhance student academic success.

To help us plan for the upcoming year we would appreciate it if you would complete this survey. Parents/guardians please complete one survey for each child you have in our schools so we can collect more accurate data. Thank you in advance for completing this survey!

Name (optional): 


A red asterisk (*) indicates required questions.


  1. Zip code*


  1. Do you have Internet access at home?*
    Yes
    No


  1. Child's gender*
    Male
    Female


  1. Child's grade Level*
    6th
    7th
    8th
    9th
    10th
    11th
    12th


  1. Who does your child live with?*
    Both parents
    Mother only
    Father only
    Guardian
    Grandparent
    Other Relative
    Foster Care


  1. Does your child have a parent/guardian currently on military deployment?*
    Yes
    No


  1. Does your child have a parent/guardian currently in jail?*
    Yes
    No


  1. What is your child's current medical insurance status?*
    Private Insurance
    Medical Card/KCHIP
    No Medical Insurance


  1. Which of the following health related issues do you feel interfere with your child's ability to learn? (Please select all issues that are currently affecting your child).*
    Dental Health
    Hearing Issues
    Head Lice
    Bed Bugs
    Immunizations
    School/Sports Physicals
    Pregnancy
    Sexual Activity
    Medication Assistance
    Drug/Alcohol Abuse Counseling
    Eating Disorders
    Nutrition
    Transportation to and from Health Visits
    Other
    None of the above


  1. If you chose "other" in the previous question, please tell us about any health issues that is not listed.


  1. Which of the following mental health issues might your child need assistance? (Please select all issues that are currently effecting your child).*
    Stress Management
    Anger/Conflict Management
    Family Counseling
    Divorce Counseling
    Grief Counseling
    Violence/Abuse Counseling
    Self-esteem Issues
    Gang Involvement
    Peer Pressure
    Bullying
    Depression
    Suicidal Thoughts
    Other
    None


  1. If you chose "other" in the previous question, please tell us about any mental health issues that is not listed.


  1. Do you feel you are able to obtain Mental Health Services when needed?*
    Yes
    No
    Unsure


  1. Do you feel like career exploration programs benefit our youth?
    Yes
    No


  1. If you have any suggestions or contacts to assist in Career Exploration, please list them below:


  1. Does your child have access to a computer (or other word processing device such as a tablet, iPad, Kindle, etc.) with regular internet access?*
    Yes
    No


  1. If you answered no to the previous question, please list how your child primarily does research and paper preparation:


  1. On which of the following child rearing topics might you like to receive training? (Please select all issues that interest you).*
    Drug/Alcohol Abuse and Prevention
    Discipline /Behavior Management
    Academic Workshops (Math, Reading, Writing, etc.)
    Current pre-teen/teen topics (sexting, technology, etc.)
    Teaching your child time management/organizational skills
    Other
    None


  1. If you chose "other" in the previous question, please tell us about any child rearing topics you would like training in that is not listed.


  1. In which of the following areas might you as a parent/guardian need assistance? (Please select all that apply).*
    Adult Education
    Finances/Budgeting
    Parenting Skills
    Employment Training
    Locating Employment
    Literacy
    Transportation for Health care when needed
    Working with my child's school
    Other
    None


  1. If you chose "other" in the previous question, please tell us about any parent/guardian assistance that you need that is not listed.


  1. Would you be interested in joining any parent/guardian groups? (If yes, please select all groups that might interest you.)*
    Grandparents (or other family members) raising children as Parents support group
    Grief
    Divorce
    Substance Abuse
    None
    Other


  1. If you chose "other" in the previous question, please tell us any groups you feel you would benefit from that is not listed.


  1. Do you feel there is a need for more after school or summer enrichment programs for students?*
    Yes
    No