To be completed by the end of Week 4 for families in
6-week programs. Please complete a separate form for each child that you
are hosting. |
Family Name: |
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City, State |
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Your E-mail: |
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Summer Miracle Child First
Name: |
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Summer Miracle Child Last
Name: |
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1. Has the child found a
family? |
Yes
No
Other, please specify. |
If
other....... |
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2. Please
describe your host child's adjustment. |
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3. What have you
noticed that has changed about the child and your hosting experience since
you wrote your previous evaluation (describe briefly and choose one answer
from the following options)? |
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It is getting more
and more challenging
It is
getting less enjoyable and more challenging
It is
equally enjoyable and challenging
It is
getting less challenging and more enjoyable
It is getting more
and more enjoyable |
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4. What
does the child like/enjoy? |
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5. What does the child
dislike/not enjoy? |
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6. What needs or
concerns do you still have that have not been met? |
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7. What has been the
best part of the visit? |
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8. What has been the
most challenging part of this visit? |
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9. What information
could have helped you manage these challenges? |
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10. Are there any other issues you would
like to discuss with Kidsave or Social Worker? |
Kidsave Representative should call
Social Worker should call |
Best Time of Day to Reach You? |
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Thank you for
your help. |
| A copy
of this completed questionnaire will be sent to Kidsave. You
will also receive a confirmation copy by return E-mail for your
records. |
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|
(Click submit to send.) |
