Needs+Assessment

Dear Residents of the Ronald McDonald Home,

We are students from **Class** of 2011 from the Moreno Valley College, Dental Hygiene Program at the Moreno Valley College. We would like to support you and your family during this difficult time. Below is a brief survey for us to help determine how we can best serve you. We thank you in advance for taking time to complete this survey and look forward to serving yourself, your family and the Ronald McDonald **Home.**

 1. How many hours are you at the building of the Ronald McDonald Home?

 2. How far away are you from your primary residence?   4. How many other children stay with you at the house?   5. What things do you miss from home that would make you feel comfortable?     6. Is there anything from your home or daily life you wish you had at the Ronald McDonald **Home**, if so please state? **Questions #5 & 6 are essentially the same question. **   7. Are there any of the following that you would like? Please circle all that apply. <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 11pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"> Game Night <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 11pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"> Magazines/Books <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 11pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"> Special Meals <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 11pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"> Crafts <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 11pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"> Other

<span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 11pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"> 8. Do you feel you have adequate support from the community or groups in the area? Please circle your response. Yes No Unsure

<span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 11pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"> 9. Do you feel you have all the information about the city resources what is available in the area you are staying in? Please circle your response. Yes No Somewhat

<span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 11pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"> 10. Is there anything that was not mentioned that you would find beneficial or helpful to you and

<span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 11pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"> your family?

<span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 11pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"> Thank you for taking time to complete this survey. Please return this to the basket at the front desk.