Fillable (EXAMPLE) JOM NEEDS ASSESSMENT SURVEY

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(EXAMPLE) JOM NEEDS ASSESSMENT SURVEY

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(EXAMPLE)
JOM NEEDS ASSESSMENT SURVEY
1. PLEASE CHECK BELOW ANY NEEDS THAT SHOULD BE PROVIDED
THROUGH THE JOM PROGRAM TO NATIVE AMERICAN STUDENTS.
A. Tutoring: Elementary
Secondary
B. Indian Cultural Programs
C. Math/Science Improvement
D. Reading/Language Improvement
E. School Supplies
F. Career Counseling or Higher Education Orientation
G. Educational Support (list)
H. Other Suggestions:
2. SELECT YOUR CHOICE OF THE THREE (3) MOST IMPORTANT NEEDS
LISTED ABOVE.
1.
2.
3.
3. HOW DO YOU THINK YOUR JOM FUNDS COULD BE USED TO ENABLE
INDIAN STUDENTS TO EQUALLY PARTICIPATE IN ANY SCHOOL
ACTIVITIES?
4. PLEASE CHECK THE CATEGORY THAT BEST DESCRIBES YOU:
PARENT/GUARDIAN IN LOCO PARENTIS
PLEASE COMPLETE AND RETURN BY:
kc/needs assessment survey
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(EXAMPLE) JOM NEEDS ASSESSMENT SURVEY

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Completed 1 February 2022

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