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  5. Bethel Midtown Village Parent Survey
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Contact Information
First Name : 
Last Name : 
Phone : 
Email Address : 
 
 
 
Highest Level of Education
 
High School Diploma
 
GED
 
Some College
 
College Degree
 
Did not complete High School

 
 
 
Name/Age/ Grade of Child 1
   
 
 
 
Name/Age/ Grade of Child 2
   
 
 
 
Name/Age/ Grade of Child 3
   
 
 
 
Name/Age/ Grade of Child 4
   
 
 
 
Name/Age/ Grade of Child 5
   
 
 
 
Does any of the children above require IEP or any learning disabilities at school? If so, who?
   
 
 
 
In what areas of learning would you like for your children to receive help with?
 
Reading
 
Math
 
Writing
 
Numbers/Letters/Shapes/Colors
 
Sight Words

 
 
 
Are their any areas that you would like to receive assistance with?
 
Obtaining GED
 
Resume/Job Search
 
Life Skills
 
Financial Literacy
 
Furthering Education