Beaumont ISD Hurricane - Student Impact Survey

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

As our community unites to recover from the harsh effects of Hurricane Harvey, we need your assistance in determining the overall impact on Beaumont ISD families.

Please complete this brief survey to help us gather information about our students and how the district can help to address needs as we move forward.

Critical response team members from the District continue to monitor improving conditions and recovery efforts in our area in order to ensure we are able to safely welcome students and staff back to our campuses and facilities.

Student's Last Name: *

Apellido del estudiante:

Student's First Name *

Primer del estudiante:

Student's Date of Birth *

Fecha de nacimiento: (mes/dia/año)

YYYY

Student's School ID# (If known)

This is the student's lunch number.

Grade Level

Grado

Campus Student Enrolled to Attend:

Parent's Name: *

Nombre del padre

Parent's Contact Number:

Parent's Email:

My family was impacted by Hurricane Harvey:

Minimally (Little to no damage; family still able to live in home and function well)

Moderately (Health, House and Vehicles incurred some damage and still without power)

Severely (Complete loss of home, vehicles, etc.,)

Other (please specify)

Is your family currently evacuated from your home? *

Yes/Si

What type of housing are you currently in? *

In our own home/apartment/public housing

Shelter/Transitional Housing

Hotel/Motel

RV/Campground

Friend's/Relative's Home

Other

Address Where Student Currently Sleeps at Night: *

Dirección done duerme cada noche:

Will your student return to attend school when BISD reopens? *

YES, my student plans to return when the district reopens.

NO, my student will not be able to return when the district reopens.

I am unsure whether my student will be able to return.

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Beaumont Independent School District. Report Abuse

Forms