Thank you for participating in this research project to better understand the lasting impacts of Nia House on our students.  

All information will remain confidential. 

Child's Date of Birth *
Child's Date of Birth
Child's race/ethnic background: *
Check all that apply.
Language your child first learned when they began to speak? *
What grade is your child in now (2018)? *
After Nia House, what type of school did your child attend? *
How many years did your child attend Nia House? *
My child is reading: *
Has your child been suspended or expelled from school? *
Check all that apply.
On average, how many days does your child miss school per year? *
My child seems interested in school. *
Select one.
Highest parent education level: *
Parent's first language or language spoken in the home: *
Parent's race/ethnic background: *
Check all that apply.
Parent's race/ethnic background:
Race/ethnic backgroud of second parent if in a two parent household. Check all that apply.
Did your family receive financial assistance while at Nia House?  *
How many people live in your home? *
What is your family's gross annual income?
Nia House academically prepared my child for elementary school: *
Nia House emotionally prepared my child for elementary school: *
Consider academic, social, and emotional skill sets.
I feel connected to and informed about my child's academic experience. *
I am able to advocate and seek support for child in their school experience. *
Are you willing to submit your child’s report card and California Standard test scores (STAR): *
May we contact you for ongoing information? *
For follow up to receive report card and test scores.
I am happy
I am happy