Grounding Roots Virtual Learning

Grounding Roots Virtual Learning

Student Interest Survey
Parent or Guardian's Name*

First NameLast Name
Student's Name*

First NameLast Name
Student's Age*
Student's Grade*
Parent's E-mail*
Student's E-mail
example@example.com
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Which Tribe is your student affiliated with?*
Yes, Very involvedYes, a littleNot reallyNo, but wants to learn
If so, what do they enjoy participating in?
YesNo
If so, what types of accommodations are helpful?
YesNo
If so, what is your student allergic to?
BeadingWeavingIndigenizing ApparelSewingDrummingLanguageHistoryNutrition and WellnessDrawing and PaintingWood CarvingInstrument MakingDecolonized SystemsMoccasinsBagsLeather WorkRibbon WorkFeather WorkNecklaces and other Jewelry MakingAccessoriesOther
Are there other things not listed or any specific type of craft or content that your student is interested in learning?
Tell Me MoreYesNoMaybeOther
Tell Me MoreYesNoMaybeOther
Tell Me MoreYesNoMaybeOther
SeesawCanvasGoogle ClassroomZoomOther
MondayTuesdayWednesdayThursdayFridaySaturdaySunday
Which TIMES are best for your student to participate in our classes or talking circles?*
Is there anything else you'd like us to know about your student or family?
Should be Empty: