LITERACY MONTH 2014 Parent Survey
RequiredRequired Question(s)
Required 1.

My child has their own library card. (If they are not able to have their own,  I have one)

Yes
No
  • Comment:

  • 500 characters left.
Required 2.

My child visits the library or a bookstore with me or another adult at least twice a month.

Yes
No
  • Comment:

  • 500 characters left.
Required 3.

My child is read to at least four times per week.

Yes
No
  • Comment:

  • 500 characters left.
Required 4.

My child has at least 15 books of their own.

Yes
No
  • Comment:

  • 500 characters left.
Required 5.

I read the activities and resources in the email from Self Help Inc. CFCE November is Literacy month!

Yes
No
  • Comment:

  • 500 characters left.
Required 6.

My child/ren and I participated in at least one of the activities listed in the email November is Literacy month!



Yes
No
  • Comment:

  • 500 characters left.
7.

Another way I foster my child/ren’s literacy skills are............

 

350 characters left.
Required 8.

Please provide the ages of the children in your home.

 

50 characters left.
Required 9.

In order to receive your free children's book,  please enter the information indicated below.


PARENT INFORMATION (for mailing purposes)


First Name:
Last Name:
Home Phone:
Email Address:
emailaddress@xyz.com
Address 1:
City:
State/Province
(US/Canada):
Postal Code: