Back-to-School Parent Survey

Ask parents about their household's remote-learning setup and comfort level with different reopening scenarios to help plan the new term.

Use this template

Page 1

Parent/Guardian Information

Your Name

Nombre

Apellido

Phone Number

Address

Dirección

Ciudad

Estado / Provincia

Código postal

How many school-aged students live in your home?

Is anyone in your household in a high-risk group for COVID-19 or other diseases?

Yes, someone is at risk

Is anyone in your household working in a high-exposure area during the pandemic?

Yes No

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