Homeless Services Survey

Homeless Services Survey
Welcome!

Please take a moment to rate your experience receiving instructional services through Klamath Falls City Schools or non-instructional services through Integral Youth Services as part of the McKinney-Vento Homeless Assistance Act of 1987 as reauthorized in 2002.

Your confidentiality is assured. Only aggregate data will be shared for program planning purposes.

Thank you.
Is finding shelter usually a problem for you?*

UsuallySometimesRarelyNever
Did you spend any nights in any of these places during the past 90 days?*

A home that you ownedAn apartment or home that you paid rent toA boarding house, halfway house, or board and care facilityA foster home including group facility, non-family caregiver, or family caregiverA hotel or motel room that you paid forThe room or home of a family member lacking guardianship and not receiving assistance for your careThe room or home of a non-family memberA camping ground, RV park, or public areaIn a mission, women's or men's shelter, or transitional shelter programIn an abandoned buildingIn a car or other motor vehicleOn the street or other outdoor placesOther
How long have you lived in Klamath Falls?*

Less than 90 days3 to 6 months6 months to 1 year5-10 yearsMore than 10 yearsEntire life
Did you met with our Homeless Liaison?*

YesNo
What type of school services were you most in need of?

Free breakfast/lunch programSpecial transportation to/from the school of originSchool supply fees (instructional supplies only)Immediate enrollment at the school of origin, or my neighborhood schoolAssistance obtaining important documents including birth certificate, immunization/health records, previous school records, and/or proof of residenceTutoring servicesHomework helpAfter school programsSummer school programFAFSA assistance for unaccompanied homeless youth looking to apply to collegeReferral(s) to homeless assistance programsOther
How would you rate the services received from Klamath Falls City Schools?

Very wellSomewhat helpfulNot sureUnawareOther
Did you met with an Integral Youth Services "Homeless Education Liaison Program" (HELP) caseworker?*

YesNoOther
Did you need a referral or assistance for any of the following through IYS?

Temporary Assistance for Needy Families (TANF)Food stampsWomen with Infants and Children (WIC)Oregon Health PlanHousing and Urban Development (HUD) emergency or low-income housingKlamath Tribes Housing Department housing for eligible low-income Native American families residing in Klamath County, with preference given to Tribal members, elders, and families with childrenMarta's HouseEmploymentClothingLegal aidChild supportHygiene productsMental healthOther
How would you rate the services received from Integral Youth Services?

Very wellSomewhat helpfulNot sureUnawareOther
Do you have any questions or comments that you would like to share with Klamath Falls City Schools about the McKinney-Vento Homeless Assistance Act program?
OPTIONAL: If you would like someone from KFCS to contact you, please provide your name and best method to reach you. Thank you.
Name (optional)

PrefixFirst NameMiddle NameLast NameSuffix
Email (optional)
example@example.com
Phone Number (optional)

Area CodePhone Number
Address (optional)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Should be Empty: