Miamisburg 2023

Kindergarten Parent Survey

Welcome to Miamisburg Schools!

Our district is participating in a countywide survey of parents with young children. Sponsored by Preschool Promise -- a program designed to help families find and afford high-quality Preschool, the survey will be used to help improve resources for preschoolers and their families. Please tell us the experiences your child has had prior to Kindergarten. Your information will be kept confidential.

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* 1. I hereby give consent for the information below and the KRA (Kindergarten Readiness Assessment) and ODE required diagnostic assessment scores in grades 1 through 3 to be shared with Preschool Promise and their research partner, the University of Dayton Business Research Group, for the sole purposes of this project. Personal information will be kept strictly confidential and will not be shared in any reports or analysis.

Yes, I give consent.

No, I do not give consent.

Parent Name:

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* 2. Today's Date:

Please fill in today's date.

Date

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* 3. Child's Name

Child's First Name

Child's Last Name

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* 4. Child's Birth Date

Birth Date of Child Entering Kindergarten

Date

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* 5. Child's Gender

Male

Female

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* 6. Primary Spoken Language at Home

English

Spanish

Other (please specify)

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* 7. Child's Race & Ethnicity

African American

Asian

White/Caucasian

Hispanic/Latino

Other (please specify)

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* 8. Child's Address

Street Address

City

State

Zip Code