Family Survey (HC)

Please complete the form below. Required fields marked with an asterisk *

Non elèv ou a (yo) [Name of your student(s)]*

Answer Required

3. Tanpri endike lang yo pale lakay pitit ou a (yo): (Home Language)

Answer Required

Angle (English)

Panyòl (Spanish)

Pòtigè (Portguese)

Kreyòl ayisyen (Haitian Creole)

Franse (French)

Vyetnamyen (Vietnamese)

Arab (Arabic)

Nepalè (Nepali)

Other:

4. Èske ou gen yon timoun ki gen yon Plan Edikasyon Endividyalize (IEP) pou bezwen edikasyon espesyal? (IEP)

Answer Required

Wi (Yes)

Non (No)

5. Èske pitit ou / pitit ou yo ap aprann angle (AA)? (EL)

Answer Required

Wi (Yes)

Non (No)

6 Si elèv ou a ale nan yon sant eLearning, tanpri di nou konbyen fwa: (e-Learning Center attendance)

Answer Required

5 jou (5 Days)

3-4 jou (3-4 Days)

1-2 jou (1-2 Days)

Elèv mwen an (yo) pa ale nan sant eLearning (My student(s) does not attend an e-Learning Center)

7. Konbyen èdtan pa jou pitit ou a (yo) swiv lekòl lakay li? Sa a gen ladan tan ki pase nan kou sou entènèt, fè travay pwofesè bay poukont li, ak devwa. (Hours spent on e-Education at home)

Answer Required

Mwens pase yon èdtan (Less than 1 hour)

1-2 èdtan (1-2 hours)

2-3 èdtan (2-3 hours)

3-4 èdtan (3-4 hours)

4-6 èdtan (4-6 hours)

6+ èdtan (6-plus hours)

8. Panse estrikteman sou teknoloji, ki sa ki pi byen dekri jounen lekòl la pou elèv ou yo ak fanmi yo: (Characterize technology/assistance)

Answer Required

Elèv mwen an ouvri sesyon an epi li fini travay yo san asistans teknik nan men yon moun kao gade l’. (My student(s) logs in and completes his/her work without any technical help from a caregiver.)

Elèv mwen an (yo) bezwen èd pou konekte ak enstale li nan maten, men li pa bezwen èd yon moun kap gade l’ pou tout rès jounen an. (My student(s) needs help getting logged in and set up in the morning, but does need any help from a caregiver for the remainder of the day.)

Elèv mwen an (yo) bezwen asistans teknik modere pandan tout jounen an. (My student(s) needs a moderate amount of technical assistance throughout the day.)

Elèv mwen an (yo) bezwen anpil asistans teknik pandan tout jounen an. (My student(s) needs a significant amount of technical assistance throughout the day.)

9. Depi elèv ou yo ouvri sesyon nan eEducation nan kòmansman chak jou, sa ki pi byen dekri jou lekòl la nan yon pèspektiv aprantisaj ak sosyo-emosyonèl: (Characterize learning and social/emotional experience)

Answer Required

Li travay poukont li, san okenn èd oswa ankourajman nan men yon moun kap gade l’. (He/she works independently, without any assistance or a encouragement from a caregiver.)

Li / li travay avèk anpil ti èd oswa ankourajman nan men yon moun kap gade l’.. (He/she works with very little assistance from a caregiver.)

Li bezwen èd modere pou li rete angaje nan travay lekòl la pandan tout jounen an. (He/she needs a moderate amount of help staying engaged in schoolwork throughout the day.)

Li bezwen anpil èd pou l rete angaje nan travay lekòl la pandan tout jounen an. (He/she needs a significant amount of help staying engaged in schoolwork throughout the day.)

10. An eneral, ki jan ou ta dekri kantite travay pwofesè pitit ou a (yo) ba li yo? (Satisfaction with level of work)

Answer Required

Twòp travay bay. (Too much work is assigned)

Jis bon kantite travay la bay. (Just the right amount of work is assigned)

Twò piti travay bay epi pitit mwen an gen tan pou li fè plis si yo ta ofri li oswa atann de li. (Too little work is assigned, and my child has time to do more work if it were offered or expected)

12. Orè klas pitit mwen an fasil pou swiv. (Student's class schedule)

Answer Required

Totalman dakò. (Strongly agree)

Dakò (Agree)

Pa dakò. (Disagree)

Pa dakò ditou (Strongly disagree)

13. Si mwen bezwen èd, mwen gen plis chans poum kontakte: (Point of contact)

Answer Required

Pwofesè pitit mwen an (My child's teacher)

Yon lyezon familyal (A Family Liaison)

Direktè pitit mwen an oswa asistan direktè a (Principal or Assistant Principal)

14. Lè mwen mande èd, mwen santi lekòl / pwofesè mwen an reaji. (Support is responsive)

Answer Required

Totalman dakò. (Strongly agree)

Dakò (Agree)

Pa dakò. (Disagree)

Pa dakò ditou (Strongly disagree)

15. Pi gwo enkyetid mwen de elèv mwen an (yo) pandan aprantisaj a distans lan se: (Biggest concern)

Answer Required

Kwasans akademik li (His/her academic growth)

Sante sosyo-emosyonèl li (His/her social-emotional health)

Absans aktivite ki pa nan kourikoulòm lan ak / oswa atletik (The absence of extracurricular activities and/or athletics)

Pa gen gwo enkyetid (No major concerns)

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Family Survey (HC)