Family Survey on Child Care
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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.

1. Please indicate your Town of Residence

Please indicate your Town of Residence

2. Please indicate your Zip Code

Please indicate your Zip Code

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

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)

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

Please indicate the ages (in years) of the children who live with you. Child#1
Child#2
Child#3
Child#4

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

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

Spanish

Hmong

Punjabi

Other (please specify)

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

7. Do you have a child with a disability?

Do you have a child with a disability? Yes

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

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

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

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)

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

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

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

Are you getting help paying for your child care? Yes

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

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)

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

How many times during the past 12 months did your child care arrangements change? No change

1 time

2 times

3 or more times

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

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

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Family Survey on Child CareExit this survey >>

1. Introduction

Family Survey on Child Care
Exit this survey >>