Survey & Petition Form Thank you for completing this survey. We value your feedback in shaping our proposed new charter high school. You must be 18 years of age or older to respond. 1. In which school district do you live?*Susquehanna TownshipSteelton-HighspireCentral DauphinHarrisburg2. Do you have a child(ren) attending a public school in one of the districts above?*YesNo3. Which grade(s) is/are your child(ren) enrolled (circle one for each child)?* Pre-K – 5 6 7 8 9 10 11 12 4. Are you satisfied with your or your child(ren)’s school(s)? Select one.*Very DissatisfiedDissatisfiedSomewhat DissatisfiedSomewhat SatisfiedSatisfiedVery Satisfied5. What do you believe are the greatest challenges present in the school your child(ren) attend(s)?*6. Do you think there is a need for a charter school to serve youth in your neighborhood?*YesNoUnsurePNMC Charter School will apply to open a high school in 2020 or 2021. PNMC CS will serve students in grades 9-12 and will offer a pre-college nursing program, student supports (e.g., counseling, health, and human services), and alumni services.7. Would you consider enrolling or enrolling your child(ren) in this new charter school?*YesNoUnsure8. From an academic, social, and/or emotional perspective, what programs or experiences would you like PNMC Charter High School to provide the well-deserved young people in your community*Thank you for completing this survey. We value your feedback in the design of our proposed charter high school. By signing the petition below, you are supporting the application and the opening of PNMC Charter School. Thank you for your interest and feedback!Name* First Last Address* Street Address Address Line 2 City StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Consent / Digital Signature*By filling in your legal name you are signing the petition, and are supporting the application and the opening of PNMC Charter School. Thank you for your interest and feedback! First Middle Last Today's Date* Date Format: MM slash DD slash YYYY PhoneThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms. 10% of Pennsylvania’s registered nurses are minority. 70% of Harrisburg residents are minority. This creates an enormous demand for increasing diversity within our local nursing workforce.