JHS 292 Parent Information Form

PARENT INFORMATION & SURVEY FORM
Form Submission Date
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Hour MinutesAM/PM Option
- Parent/Guardian
  First NameLast Name
- Home Address
  Street Address
  Street Address Line 2
  CityState / Province
  Postal / Zip Code
- Mobile Phone Number #1
  Enter valid mobile number. Will also be used to receive text msgs. Format: (000) 000-0000.
- Phone Number #2
  Please enter a valid phone number.Format: (000) 000-0000.
- Phone Type
- Email Address
- Child's Name #1
  First NameLast Name
- Grade
- Parent/Guardian
- Child's Name #2
  First NameLast Name
- Grade
- Parent/Guardian
- Emergency Contact:
  First NameLast Name
- Emergency Contact Phone Number
  Format: (000) 000-0000.
- Have you registered with your STUDENT ACCOUNT?
  If not, please contact Juanita Jenkins, PC for assistance in acquiring your NYCSA Creation Code and registration instructions.
- Is your child(ren) registered with their STUDENT ACCOUNT?
  If not, please contact Juanita Jenkins, PC for assistance in acquiring your NYCSA Creation Code.
- What Informational Resource(s) Are You Most Interested In?
  Select ALL that Apply! Enter Additional Resources Not listed, in the Comments Section below.
- What is your preferred form of communication?
- The best time for me to participate in a school related meeting, or activities is:
  Select all that apply.
- Select ALL workshops you'd like to attend:
  Click all that apply
- What other workshop topics do you suggest be provided:
  Enter up to 3 suggestions separated by commas.0/50
- I would like to volunteer for the following:
  Select ALL that Apply!
- How do you rate the safety of the school?
  
  1 Very Bad 2 Bad 3 Good 4 Very Good 5 Excellent
- How do you rate the PTA's Parent engagement efforts?
  
  1 Very Bad 2 Bad 3 Good 4 Very Good 5 Excellent
- How do you rate the Parent Coordinator's engagement efforts?
  
  1 Very Bad 2 Bad 3 Good 4 Very Good 5 Excellent
- Do you feel welcome in the building?
  
  Never Sometimes Always
- How would you rate this form?
  
  1 Bad 2 Okay 3 Good 4 Great 5 Excellent
- Select the reason for your engagement:
- COMMENTS:
  Enter any question or additional information pertaining to the contents and or the purpose of this form., in 50 words or less.0/50
- Should be Empty:

PARENT INFORMATION & SURVEY FORM