Family Engagement Survey

Culturally Responsive Multi-Level System of Supports

[school name] is implementing a culturally responsive multi-level system of supports. This is a framework to ensure that we meet the needs of all students by providing academic and behavioral supports of increasing intensity based on student need. These supports are commonly known as PBIS and RtI. We are conducting this survey to see what families already know and need to know about our existing supports. Please answer the following questions. The answers you provide will tell us what we need to do to help families understand how we are meeting student needs. Thank you very much for your help. If you have questions about this, please call ______or stop in the office and talk to ______.

Grade of your child/children ______

Yes / No
1. Have you heard of PBIS from someone within the school?
2. Have you heard of RtI from someone within the school?
3. If you can, please list the school’s behavior expectations
4. Have you used these behavioral expectations at home?
5. Has your child/student received any acknowledgements [paw slips] demonstrating the school’s expectations since school started?
6. Have you noticed a change in behavior and/or attitude in the school? If yes, what have you noticed:
7. Are you aware of a team in the school that addresses school wide behavior supports?
8. Are you aware of any family members on that team?
9. Are you aware of the academic standards that your child is expected to know and be able to do by the end of this school year?
10. Have you received information about your child’s universal screening results?
11. Did you understand the information you received about your child’s universal screening?
12. Have you received any positive comments about your child’s behavior from a teacher or staff member?
13. Have you received any negative comments from a teacher or staff member about your child’s behavior?
14. Are you aware of a team in the school that addresses children’s academic concerns?
15. Have you been informed of what happens when your child’s teacher has concerns about his/her academic skills?
16. Do you know who to contact if you have concerns about your child’s academic progress or behavior?
17. Do you know how families are informed of their child’s response to interventions or supports?

If you have any comments about any of the above questions, use the space below. Your help is greatly appreciated. Thank you once again for helping to make our school a better place for everyone, especially our children.

______

Adapted from Iowa Dept. of Ed. Revised: March, 2016 (DJS)