Social Assessment
QuestionResponseComment
TRANSPORTATION PROBLEM
SINGLE PARENT
DEPENDS ON DAYCARE
IMPRISONMENT OF PARENT
ACTIVE DUTY MILITARY PARENT
VETERAN PARENT
HOMELESS
UNEMPLOYED PARENTS
NO ENGLISH SPOKEN AT HOME
RECENT IMMIGRANT <5 YEARS
VISUALLY IMPAIRED PARENT
HEARING IMPAIRED PARENT
DISABLED PARENT
VICTIM OF DOMESTIC VIOLENCE
MENTALLY DISABLED PARENT
EXTENDED FAMILY SUPPORT
MIGRANT FARM WORKER
HOME IS BUILT < 1978
EXPOSURE TO INDUSTRIAL CHEMICALS
EXPOSURE TO CIGARETTE SMOKE
NO DENTAL VISIT THIS YEAR
PARENT CAN’T READ OR WRITE
PARENTAL ALCOHOL ADDICTION
PARENTAL DRUG ADDICTION
SEVERE DENTAL DECAY
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