Family Survey on Child Care

1. Introduction

Thank you for taking time to complete this survey. Your input will assist the Child Care Planning Council of Yuba & Sutter Counties in getting a better picture of families' needs for early education and care in their community. All answers will be kept confidential. Please complete only one survey per family.
Please Note: The term "early education and care" is meant to include all types of care for your children, including: family child care, center-based care, Head Start, preschool, nursery school, public school, kindergarten, school-age care, babysitters, relative care, nannies and parental care.

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* 1. Please indicate your Town of Residence

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* 2. Please indicate your Zip Code

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* 3. What describes your family? Please check all that apply.

2-parents/guardians living in the home

1 parent/guardian living in the home

Extended family (grandparents or other relatives living in the home)

Other (please specify)

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* 4. Please indicate the ages (in years) of the children who live with you.

Child#1

Child#2

Child#3

Child#4

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* 5. What language(s) are spoken in your home? (Please check all that apply.)

English

Spanish

Hmong

Punjabi

Other (please specify)

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* 6. What types of care do you currently have for your children? (Please answer for only your youngest four children)

	Child #1	Child #2	Child #3	Child #4
Parent/Guardian at home with child(ren)	Parent/Guardian at home with child(ren) Child #1	Parent/Guardian at home with child(ren) Child #2	Parent/Guardian at home with child(ren) Child #3	Parent/Guardian at home with child(ren) Child #4
Family member, grandparent, neighbor or friend in your home	Family member, grandparent, neighbor or friend in your home Child #1	Family member, grandparent, neighbor or friend in your home Child #2	Family member, grandparent, neighbor or friend in your home Child #3	Family member, grandparent, neighbor or friend in your home Child #4
Family child care/Home-based care in the caregivers' home	Family child care/Home-based care in the caregivers' home Child #1	Family child care/Home-based care in the caregivers' home Child #2	Family child care/Home-based care in the caregivers' home Child #3	Family child care/Home-based care in the caregivers' home Child #4
Private Child Care Center/Preschool	Private Child Care Center/Preschool Child #1	Private Child Care Center/Preschool Child #2	Private Child Care Center/Preschool Child #3	Private Child Care Center/Preschool Child #4
Head Start/Early Head Start	Head Start/Early Head Start Child #1	Head Start/Early Head Start Child #2	Head Start/Early Head Start Child #3	Head Start/Early Head Start Child #4
State Preschool/Children's Center (Operated by School District)	State Preschool/Children's Center (Operated by School District) Child #1	State Preschool/Children's Center (Operated by School District) Child #2	State Preschool/Children's Center (Operated by School District) Child #3	State Preschool/Children's Center (Operated by School District) Child #4
After-school program	After-school program Child #1	After-school program Child #2	After-school program Child #3	After-school program Child #4

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* 7. Do you have a child with a disability?

Yes

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* 8. If you have a child with a disability, have you had difficulty finding care for your child?

Yes

I do not have a child with a disability

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* 9. In the past 12 months, what were your three biggest problems in finding or using child care/preschool? (Please check all that apply)

Cost

Transportation

Location

Hours of Care

Trust of Staff

Program Content/Philosophy

Could not find program/Long Waiting List

Lack of Services for children with special needs

No problems

Other (please specify)

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* 10. About how much do you spend on child care each week?

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* 11. Are you getting help paying for your child care?

Yes

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* 12. If you are getting help to pay for your child care, what type of help are you getting?

Financial support from a relative

Child care through my employer

Financial support from the government (i.e. voucher, Head Start, CHS)

I do not get help paying for my child care

Other (please specify)

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* 13. How many times during the past 12 months did your child care arrangements change?

No change

1 time

2 times

3 or more times

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* 1. Please indicate your Town of Residence

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* 2. Please indicate your Zip Code

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* 3. What describes your family? Please check all that apply.

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* 4. Please indicate the ages (in years) of the children who live with you.

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* 5. What language(s) are spoken in your home? (Please check all that apply.)

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* 6. What types of care do you currently have for your children? (Please answer for only your youngest four children)

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* 7. Do you have a child with a disability?

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* 8. If you have a child with a disability, have you had difficulty finding care for your child?

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* 9. In the past 12 months, what were your three biggest problems in finding or using child care/preschool? (Please check all that apply)

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* 10. About how much do you spend on child care each week?

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* 11. Are you getting help paying for your child care?

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* 12. If you are getting help to pay for your child care, what type of help are you getting?

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* 13. How many times during the past 12 months did your child care arrangements change?

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* 14. Please provide us with any other comments you have on this subject of the need for child care.