If there are no children age 17 or younger who usually live in your household , please skip to next question

• Child 1

  
  

  Gender Male Female
  

  Relationship with you? Son/Daughter Grandchild Relative Other
  

  
  

  If child is 14 or older, do they intend to apply for college? Yes No Undecided Under 14 years old Homeschool Other
  

  On February 1, 2018, what School was this child in? Muslim Academy Public School Charter School Private School Homeschool Other
  

  
  

• Child 2

  
  

  Gender Male Female
  

  Relationship with you? Son/Daughter Grandchild Relative Other
  

  
  

  If child is 14 or older, do they intend to apply for college? Yes No Undecided Under 14 years old Homeschool Other
  

  On February 1, 2018, what School was this child in? Muslim Academy Public School Charter School Private School Homeschool Other
  

  
  

• Child 3

  
  

  Gender Male Female
  

  Relationship with you? Son/Daughter Grandchild Relative Other
  

  
  

  If child is 14 or older, do they intend to apply for college? Yes No Undecided Under 14 years old Homeschool Other
  

  On February 1, 2018, what School was this child in? Muslim Academy Public School Charter School Private School Homeschool Other
  

  
  

• Child 4

  
  

  Gender Male Female
  

  Relationship with you? Son/Daughter Grandchild Relative Other
  

  
  

  If child is 14 or older, do they intend to apply for college? Yes No Undecided Under 14 years old Homeschool Other
  

  On February 1, 2018, what School was this child in? Muslim Academy Public School Charter School Private School Homeschool Other
  

  
  

• Child 5

  
  

  Gender Male Female
  

  Relationship with you? Son/Daughter Grandchild Relative Other
  

  
  

  If child is 14 or older, do they intend to apply for college? Yes No Undecided Under 14 years old Homeschool Other
  

  On February 1, 2018, what School was this child in? Muslim Academy Public School Charter School Private School Homeschool Other
  

  
  

• When speaking, are you bilingual (English or Arabic dominant), English only, or Arabic only?

  Bilingual (English dominant) Bilingual (Arabic dominant) English only Arabic only
  

  Do you live in the Greater New Orleans area (including the Westbank) for any part of the year?

  Yes No
  

  How long have you lived in the United States?

  Less than 1 year 1 to 4 years 5 to 9 years 10 to 14 years 15 to 24 years More than 25 years All my life
  

  How long have you lived in Louisiana?

  Less than 1 year 1 to 4 years 5 to 9 years 10 to 14 years 15 to 24 years More than 25 years All my life
  

  Would you be interested in sending your child to an after-school program for tutoring leadership development, and/or college application assistance?

  Yes No Dont Know Dont Care
  

  Would you or your spouse be interested in taking an English as Second Language (ESL) class to learn how to speak, write, and read in English?

  Yes Yes, only if evening classes Yes, only if women only classes No Does not apply to my household because English not second language
  

  How do you prefer to learn about new programs, services and local announcements? (check up to two)

  Social media or online communication (like WhatsApp or Viber) Website for Silwad community Flyers or posters Email Text Messages None

  What time do you prefer Silwad community meetings to be held? (check up to two)

  Saturday 8 AM Sunday 8 AM Monday 8 AM Tuesday 8 AM Wednesday 8 AM Thursday 8 AM Friday 8 AM Saturday 9 PM Sunday 9 PM Monday 9 PM Tuesday 9 PM Wednesday 9 PM Thursday 9 PM Friday 9 PM