I'm posting this as a favor to a young lady that is wanting to survey parents of CF children that are enrolled in public school. She is doing this survey as part of a class. Her boyfriend has CF.
I saw this survey on another CF website & asked if I may post it here, thinking she would get a better response simply because there are more Users here. She said you could respond here or email the survey to her at onesweetmuffen@aol.com
Here it is:
I am a high school student conducting a survey for my quality of life research project. I am focusing on students who have Cystic Fibrosis and attend Public School. If you are a parent of a child who has Cystic Fibrosis and would like to participate please note that this is a confidential survey, so please do not write your name. Thank You.
Please check one of the following or fill in the blank for which best describes your child.
Age of child: ______
1) Gender of child: ______ Male ______ Female
2) Race of child:
______ African American ______ Asian
______ Hispanic ______ Native American
______ White/Caucasian Other(Please Specify) _________________
3) How many doctor appointments does your child have in a typical week?
______ 0 ______ 1-2 ______ 3-4 ______ 5 or more
4) How many days a week does your child leave early from school because he/she does not feel well?
______ 0 ______ 1-2 ______ 3-4 ______ 5 or more
5) How often is your child in the nurse's office a week?
______ 0 ______ 1-2 ______ 3-4 ______ 5 or more
6) How many days does your child miss in a typical school year because of CF?
______ 0-10 ______ 11-20 ______ 21-30 ______ 31-40
______ 41-50 ______ 51-60 ______ 61-70 ______ 71-80
______ 81 or more ______ Not Sure
7) Has your child ever been left back? (If no please skip question 8.)
_____ Yes ______ No ______ Not Sure
How many times has your child been left back because they were absent too many days?
______ 0 ______ 1-2 ______ 3-4 ______ 5 or more
9) Is your child enrolled in either of the following programs?
_____ IDEA ______ Section 504 ______ Neither ______ Not Sure
10) Does your child receive special help at school?
_____ Yes ______ No ______ Not Sure
11) Does your child receive any of the services listed below? (Check all that apply)
_____ Copy of teacher's material
_____ Extra time on tests
_____ Frequent breaks
_____ Note taking assistance/ Scribe
_____ Tutoring
Other (please state)
____________________________________________________________________________________________________ ____________________________________________
12) Do you feel that your child's CF makes him/her unable to focus on his/her schoolwork?
_____ Yes ______ No ______ Not Sure
13) Do you feel that the nurse and the teachers at your child's school know what he/she need?
_____ Yes ______ No ______ Not Sure
14) Please state obstacles/problems your child faces at school. (ex: unsanitary conditions or personal problems with school faculty.)
____________________________________________________________________________________________________ ____________________________________________________________________________________________________
I saw this survey on another CF website & asked if I may post it here, thinking she would get a better response simply because there are more Users here. She said you could respond here or email the survey to her at onesweetmuffen@aol.com
Here it is:
I am a high school student conducting a survey for my quality of life research project. I am focusing on students who have Cystic Fibrosis and attend Public School. If you are a parent of a child who has Cystic Fibrosis and would like to participate please note that this is a confidential survey, so please do not write your name. Thank You.
Please check one of the following or fill in the blank for which best describes your child.
Age of child: ______
1) Gender of child: ______ Male ______ Female
2) Race of child:
______ African American ______ Asian
______ Hispanic ______ Native American
______ White/Caucasian Other(Please Specify) _________________
3) How many doctor appointments does your child have in a typical week?
______ 0 ______ 1-2 ______ 3-4 ______ 5 or more
4) How many days a week does your child leave early from school because he/she does not feel well?
______ 0 ______ 1-2 ______ 3-4 ______ 5 or more
5) How often is your child in the nurse's office a week?
______ 0 ______ 1-2 ______ 3-4 ______ 5 or more
6) How many days does your child miss in a typical school year because of CF?
______ 0-10 ______ 11-20 ______ 21-30 ______ 31-40
______ 41-50 ______ 51-60 ______ 61-70 ______ 71-80
______ 81 or more ______ Not Sure
7) Has your child ever been left back? (If no please skip question 8.)
_____ Yes ______ No ______ Not Sure
How many times has your child been left back because they were absent too many days?
______ 0 ______ 1-2 ______ 3-4 ______ 5 or more
9) Is your child enrolled in either of the following programs?
_____ IDEA ______ Section 504 ______ Neither ______ Not Sure
10) Does your child receive special help at school?
_____ Yes ______ No ______ Not Sure
11) Does your child receive any of the services listed below? (Check all that apply)
_____ Copy of teacher's material
_____ Extra time on tests
_____ Frequent breaks
_____ Note taking assistance/ Scribe
_____ Tutoring
Other (please state)
____________________________________________________________________________________________________ ____________________________________________
12) Do you feel that your child's CF makes him/her unable to focus on his/her schoolwork?
_____ Yes ______ No ______ Not Sure
13) Do you feel that the nurse and the teachers at your child's school know what he/she need?
_____ Yes ______ No ______ Not Sure
14) Please state obstacles/problems your child faces at school. (ex: unsanitary conditions or personal problems with school faculty.)
____________________________________________________________________________________________________ ____________________________________________________________________________________________________