Post-Children's Homes, Inc. Report

Please answer all questions honestly. Answers gathered from this survey shall be used to provide aftercare support to children and families leaving our program and improve the program. Your identifying information shall remain confidential. Rank all questions from 1 to 5 (1=Poor, 2=Fair, 3-Good, 4-Very Good, 5=Excellent). Add comments. Answer all questions based upon the previous month.

Date

Name

Code

How are you or your child doing spiritually?

Comment

How is your child doing?

Comment

How is your family doing?

Comment

How is your child doing at school, work or college?

Comment