McKinney Vento Homelessness Survey for Families Question Title * 1. Which county do you live in? Mercer County Middlesex County Monmouth County Ocean County Question Title * 2. Did you and your child/ren move during this school year? Yes No Question Title * 3. If yes, around how many times did you move? one time two times three times four times Other (please specify) Question Title * 4. Which options best describe the cause of the move? unemployment reduced hours at work medical bills domestic violence eviction or foreclosure Other (please specify) Question Title * 5. Is your child/ren still going to the same school as the start of the year? Yes No Question Title * 6. Do you know other families experiencing homelessness in the same school system? Yes No Question Title * 7. During the past 30 days, how many school days has your child/ren missed? 0 days 1 day 2 or 3 days 4 or 5 days 6 or more days Question Title * 8. Where did you stay last night? shared living space with others motel or hotel emergency shelter car, campground, abandoned building apartment with lease in my name Other (please specify) Question Title * 9. Are you sharing living accommodations with another family? Yes No residing in a homeless shelter Question Title * 10. Where do you plan to stay tonight? shared living space with others motel or hotel emergency shelter car, campground, abandoned building permanent housing with lease in your name unknown Other (please specify) Question Title * 11. What are some obstacles that you and your child/ren face at school? access to transportation to/from school access to mental health and support services access to free school lunches access to tutoring services Other (please specify) Question Title * 12. What are some obstacles that you and your child/ren face outside of school? access to internet suitable clothing access to food dealing with housing uncertainty Other (please specify) Question Title * 13. Do you know who to talk to at school on issues relating to homelessness? Yes No Question Title * 14. Who do you think you could communicate to regarding these challenges? teachers school nurses social worker/counselor main office Other (please specify) Question Title * 15. Have you ever communicated to any of these individuals? Yes No Question Title * 16. What was the experience when communicating to the staff member/members Very positive Positive Neutral Negative Very negative Other (please specify) Question Title * 17. Please mark the top 3 school services or programs that would benefit your child/ren to succeed at school. additional transportation services additional social-emotional support services extra tutoring clothing drive school supplies designated school food pantry Other (please specify) Question Title * 18. Please enter your email if you would be interested in participating in a workgroup to discuss current barriers in the system Done