APPENDIX C: DATA COLLECTION INTRUMENTS CAREGIVER SURVEY ABOUT WALKING AND BIKING TO SCHOOL SECTION 1 - INTRODUCTION Dear Parent or Caregiver, Your child’s school would like to learn your thoughts about students walking and biking to school during a typical year. If your child’s school is currently in distance-learning because of COVID-19, think about what you would do if they were attending classes in person. This survey will take about 5 - 10 minutes to complete. We ask that each family complete only one survey per school your children attend. If more than one child attends the same school, please fill out the survey for the child with the next birthday from today's date. Your responses will be kept confidential and neither your name nor your child’s name will be associated with any results. School Name: [DROP DOWN MENU] SECTION 2 - ABOUT YOU The following questions ask about the demographics of your child and family. They will help us understand if we are reaching a representative sample of the community. The questions are optional, and your answers will remain anonymous. What is the grade of your child? [DROP DOWN] What is the gender of your child? • Male • Female • Other • Prefer not to answer What is the race/ethnicity of your child? (check all that apply) White Hispanic or Latino Black or African American Native American or American Indian Asian Native Hawaiian/Pacific Islander Other Prefer not to say What is your annual household income? • Less than $25,000 • $25,000 to $50,000 • $50,000 to $75,000 • $75,000 to $125,000 • $125,000 to $200,000 • More than $200,000 • Prefer not to say Do you speak a language other than English at home? • Yes • No
What language(s) do you speak at home? (check all that apply)
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