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Community Needs Survey

Homework Services

This survey is conducted to gain knowledge of the needs of the low socioeconomic and
disadvantaged students. The purpose and intent is to identify areas that will help students in this
population become more successful in school, which will further help them become more
successful as adults. This survey will focus on gathering information that will assist parents with
helping their students with homework.

Rate the Importance - Circle

1 = completely unimportant 2 = unimportant

3 = important 4 = very important

1. Transportation availability 1 2 3 4

2. Employment opportunities (Adult) 1 2 3 4

3. Employment opportunities (Student) 1 2 3 4

4. Affordable medical service availability 1 2 3 4

5. Dental service availability 1 2 3 4

6. Ophthalmologist availability 1 2 3 4

7. Prescription drug affordability 1 2 3 4

8. Access to affordable housing 1 2 3 4

9. Access to quality housing 1 2 3 4

10. Grocery store availability 1 2 3 4

11. Access to food pantry 1 2 3 4

12. Affordable daycare center availability 1 2 3 4

13. Day care center quality 1 2 3 4

14. Safety at school 1 2 3 4

15. Quality of teaching at school 1 2 3 4

16. After school youth activities (educational, 1 2 3 4

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cultural, recreational)

17. Opportunity to participate in religious activities 1 2 3 4

at local churches

18. Access to information about city and county family 1 2 3 4

resources

Community Needs Survey

Homework Services

19. Availability of adult service agencies 1 2 3 4

20. Availability of service provided for youth 1 2 3 4

21. Availability of recreation facilities and parks 1 2 3 4

22. Availability of free/affordable after school child 1 2 3 4

care services

23. Availability of free/affordable after school transportation 1 2 3 4

for school age children

Instructions: Please answer the following questions by circling YES or NO

1. Would you use free after school homework services for your K-12 student? YES NO

2. Would you be receptive to free afternoon snacks for your child attending
afterschool services for homework? YES NO

3. Would a 5 day-a-week homework service benefit your family? YES NO

4. Would a 3 day-a-week homework service benefit your family? YES NO

5. Would a boys/girls mentoring program benefit your family? YES NO