Please Help Us Recruit a K-6 Charter Elementary School to Downtown LA! Survey

Your personal information will NOT be shared with any third party. Rather, we will use it to contact you for outreach meetings and to keep you informed on our progress.

Thank you!

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* 1. First Name

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* 2. Last name

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* 3. E-Mail Address

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* 4. Confirm E-mail Address

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* 5. Best phone number to reach you (ex. XXX-XXX-XXXX)

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* 6. Name of your community / building (i.e. Market Lofts)

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* 7. Street address

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* 8. Zip code

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* 9. Number of children

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* 10. Child(ren)'s Age(s)

	0-1	2	3	4	5	6	7	8	9	10	11	12	13	14	15	16	17	18
Child 1	Child 1 0-1	Child 1 2	Child 1 3	Child 1 4	Child 1 5	Child 1 6	Child 1 7	Child 1 8	Child 1 9	Child 1 10	Child 1 11	Child 1 12	Child 1 13	Child 1 14	Child 1 15	Child 1 16	Child 1 17	Child 1 18
Child 2	Child 2 0-1	Child 2 2	Child 2 3	Child 2 4	Child 2 5	Child 2 6	Child 2 7	Child 2 8	Child 2 9	Child 2 10	Child 2 11	Child 2 12	Child 2 13	Child 2 14	Child 2 15	Child 2 16	Child 2 17	Child 2 18
Child 3	Child 3 0-1	Child 3 2	Child 3 3	Child 3 4	Child 3 5	Child 3 6	Child 3 7	Child 3 8	Child 3 9	Child 3 10	Child 3 11	Child 3 12	Child 3 13	Child 3 14	Child 3 15	Child 3 16	Child 3 17	Child 3 18
Child 4	Child 4 0-1	Child 4 2	Child 4 3	Child 4 4	Child 4 5	Child 4 6	Child 4 7	Child 4 8	Child 4 9	Child 4 10	Child 4 11	Child 4 12	Child 4 13	Child 4 14	Child 4 15	Child 4 16	Child 4 17	Child 4 18

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* 11. Child(ren)’s expected year(s) of entrance into kindergarten (if applicable)

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* 12. If already attending school, child(ren)’s grade in 2013

	K	1st grade	2nd grade	3rd grade	4th grade	5th grade	6th grade	7th grade	8th grade	9th grade	10th grade	11th grade	12th grade
Child 1	Child 1 K	Child 1 1st grade	Child 1 2nd grade	Child 1 3rd grade	Child 1 4th grade	Child 1 5th grade	Child 1 6th grade	Child 1 7th grade	Child 1 8th grade	Child 1 9th grade	Child 1 10th grade	Child 1 11th grade	Child 1 12th grade
Child 2	Child 2 K	Child 2 1st grade	Child 2 2nd grade	Child 2 3rd grade	Child 2 4th grade	Child 2 5th grade	Child 2 6th grade	Child 2 7th grade	Child 2 8th grade	Child 2 9th grade	Child 2 10th grade	Child 2 11th grade	Child 2 12th grade
Child 3	Child 3 K	Child 3 1st grade	Child 3 2nd grade	Child 3 3rd grade	Child 3 4th grade	Child 3 5th grade	Child 3 6th grade	Child 3 7th grade	Child 3 8th grade	Child 3 9th grade	Child 3 10th grade	Child 3 11th grade	Child 3 12th grade
Child 4	Child 4 K	Child 4 1st grade	Child 4 2nd grade	Child 4 3rd grade	Child 4 4th grade	Child 4 5th grade	Child 4 6th grade	Child 4 7th grade	Child 4 8th grade	Child 4 9th grade	Child 4 10th grade	Child 4 11th grade	Child 4 12th grade

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* 13. With current options for elementary schools in Downtown, what would you do when it’s time for your child(ren) to attend elementary school?

Send your child(ren) to current school options

Commute out of Downtown for other school options

Move out of Downtown for other school options

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* 14. If there were a quality Charter Elementary School in Downtown near South Park, would you consider sending your child(ren) to attend?

Yes

Maybe

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* 15. Comments

Thank you for your feedback! Your participation will be instrumental in our efforts.