Caregiver Deaths Survey

What county is your school located in?

Select a response

To the best of your knowledge, how many students at your school have experienced the death of a parent or other primary caregiver over the course of their lives?

For each student who’s experienced a caregiver’s death, please complete the following demographic information. Note: If you would like to provide data on more than 10 students, please email kdukes@ednc.org.

Current grade:

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Student gender:

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Student race/ethnicity:

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Grade of student at time of caregiver's death:

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Caregiver's relationship to student:

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Thank you for your time spent taking this survey.

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