Parent and Guardian Needs Assessment
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1. Default Section

1. What is your role in Haddam-Killingworth? Check all that apply.

What is your role in Haddam-Killingworth? Check all that apply. Parent/guardian of child 0-3 years old Parent/guardian of child 4-5 years old Parent/guardian of child in Elementary school Parent/guardian of child in Middle school	Parent/guardian of child in High school Regional School District #17 employee Preschool teacher Childcare provider	Work in Haddam Work in Killingworth Resident of Haddam Resident of Killingworth
Other (please specify)

2. What challenges does your family face? Check all that apply.

What challenges does your family face? Check all that apply. Parenting without support of extended family and/or friends Difficulty staying within a spending budget Providing enough food Disabilities within household (parent/guardian or child) Transportation problems Domestic violence	Major life changes (divorce, unemployment, death, etc) Managing stress Financial problems Housing problems Health insurance coverage Receiving medical care	Single parenting Balancing wrok and family Finding affordable childcare Finding in-home childcare (babysitter, nanny, etc) Substance abuse
Other (please specify)

3. What would you be interested in learning more about? Check all that apply.

What would you be interested in learning more about? Check all that apply. Dealing with challenging behaviors What children need for school success Is my child's develop on track? Physical development in young children Speech and language development in young children Emotional development in young children Social skills development in young children How young children think and learn	Reading with my child How I can earn my GED/HS diploma Sibling rivalry Parenting Keeping my child healthy Dental care Childhood nutrition Toilet training	Sleep/bed time Participation in infant play groups Participation in toddler play groups Participation in preschool play groups Connecting with other families/supports in community Social service resources Parent leadership/advocating for children
Other (please specify)

4. Please rate how well the following options for programs or for obtaining information work for you and your family.

	Excellent	Good	Average	Fair	Poor
Written materials	*Please rate how well the following options for programs or for obtaining information work for you and your family. Written materials Excellent	Written materials Good	Written materials Average	Written materials Fair	Written materials Poor
Website	Website Excellent	Website Good	Website Average	Website Fair	Website Poor
Social networking (Facebook, Twitter, Blog, etc)	Social networking (Facebook, Twitter, Blog, etc) Excellent	Social networking (Facebook, Twitter, Blog, etc) Good	Social networking (Facebook, Twitter, Blog, etc) Average	Social networking (Facebook, Twitter, Blog, etc) Fair	Social networking (Facebook, Twitter, Blog, etc) Poor
Daytime programs	Daytime programs Excellent	Daytime programs Good	Daytime programs Average	Daytime programs Fair	Daytime programs Poor
Lunch hour programs (12-1pm)	Lunch hour programs (12-1pm) Excellent	Lunch hour programs (12-1pm) Good	Lunch hour programs (12-1pm) Average	Lunch hour programs (12-1pm) Fair	Lunch hour programs (12-1pm) Poor
Evening programs	Evening programs Excellent	Evening programs Good	Evening programs Average	Evening programs Fair	Evening programs Poor
Free programming	Free programming Excellent	Free programming Good	Free programming Average	Free programming Fair	Free programming Poor
Programming with fee	Programming with fee Excellent	Programming with fee Good	Programming with fee Average	Programming with fee Fair	Programming with fee Poor
Caregiver share groups/support groups	Caregiver share groups/support groups Excellent	Caregiver share groups/support groups Good	Caregiver share groups/support groups Average	Caregiver share groups/support groups Fair	Caregiver share groups/support groups Poor
Email	Email Excellent	Email Good	Email Average	Email Fair	Email Poor
Located at school	Located at school Excellent	Located at school Good	Located at school Average	Located at school Fair	Located at school Poor
Located in community (location other than school)	Located in community (location other than school) Excellent	Located in community (location other than school) Good	Located in community (location other than school) Average	Located in community (location other than school) Fair	Located in community (location other than school) Poor

Other (please specify)

5. What time of day are you available to attend programming for children under 5 on a weekday? Check all that apply.

What time of day are you available to attend programming for children under 5 on a weekday? Check all that apply. 8-9am 9-10am 10-11am 11-12pm 12-1pm	1-2pm 2-3pm 3-4pm 4-5pm 5-6pm	6-7pm After 7pm Not available Monday-Friday
Other (please specify)

6. What time of day would you be available to attend programming for children under 5 on a weekend? Check all that apply.

What time of day would you be available to attend programming for children under 5 on a weekend? Check all that apply. 8-9am 9-10am 10-11am 11-12pm 12-1pm	1-2pm 2-3pm 3-4pm 4-5pm 5-6pm	6-7pm Not available on Saturday Not available on Sunday
Other (please specify)

7. What type of early care/education is your child currently enrolled in? (For each program your child participates in, please check part day or full day AS WELL AS school year only or all year long)

	None	Full day	Part day	School year only	All year long
Preschool only	*What type of early care/education is your child currently enrolled in? (For each program your child participates in, please check part day or full day AS WELL AS school year only or all year long) Preschool only None	Preschool only Full day	Preschool only Part day	Preschool only School year only	Preschool only All year long
Preschool and daycare	Preschool and daycare None	Preschool and daycare Full day	Preschool and daycare Part day	Preschool and daycare School year only	Preschool and daycare All year long
Daycare only	Daycare only None	Daycare only Full day	Daycare only Part day	Daycare only School year only	Daycare only All year long
Elementary school	Elementary school None	Elementary school Full day	Elementary school Part day	Elementary school School year only	Elementary school All year long
Before school care	Before school care None	Before school care Full day	Before school care Part day	Before school care School year only	Before school care All year long
After school care	After school care None	After school care Full day	After school care Part day	After school care School year only	After school care All year long
Location in Haddam	Location in Haddam None	Location in Haddam Full day	Location in Haddam Part day	Location in Haddam School year only	Location in Haddam All year long
Location in Killingworth	Location in Killingworth None	Location in Killingworth Full day	Location in Killingworth Part day	Location in Killingworth School year only	Location in Killingworth All year long
Location outside of Haddam-Killingworth	Location outside of Haddam-Killingworth None	Location outside of Haddam-Killingworth Full day	Location outside of Haddam-Killingworth Part day	Location outside of Haddam-Killingworth School year only	Location outside of Haddam-Killingworth All year long

Other (please specify)

8. How well does your current child care/education situation fit your needs?

	Excellent	Good	Average	Fair	Poor	Not applicable
Preschool program	*How well does your current child care/education situation fit your needs? Preschool program Excellent	Preschool program Good	Preschool program Average	Preschool program Fair	Preschool program Poor	Preschool program Not applicable
Daycare setting	Daycare setting Excellent	Daycare setting Good	Daycare setting Average	Daycare setting Fair	Daycare setting Poor	Daycare setting Not applicable
Own home/relative care	Own home/relative care Excellent	Own home/relative care Good	Own home/relative care Average	Own home/relative care Fair	Own home/relative care Poor	Own home/relative care Not applicable
Hours of operation	Hours of operation Excellent	Hours of operation Good	Hours of operation Average	Hours of operation Fair	Hours of operation Poor	Hours of operation Not applicable
Cost of care/program	Cost of care/program Excellent	Cost of care/program Good	Cost of care/program Average	Cost of care/program Fair	Cost of care/program Poor	Cost of care/program Not applicable
Programs offered at daycare/preschool	Programs offered at daycare/preschool Excellent	Programs offered at daycare/preschool Good	Programs offered at daycare/preschool Average	Programs offered at daycare/preschool Fair	Programs offered at daycare/preschool Poor	Programs offered at daycare/preschool Not applicable
Parent-teacher communication	Parent-teacher communication Excellent	Parent-teacher communication Good	Parent-teacher communication Average	Parent-teacher communication Fair	Parent-teacher communication Poor	Parent-teacher communication Not applicable
School readiness	School readiness Excellent	School readiness Good	School readiness Average	School readiness Fair	School readiness Poor	School readiness Not applicable

Other (please specify)

9. Indicate any difficulties you have had in finding the kind of program(s) you want for you child/ren. Check all that apply. (Space below can be used for further explanation of any answers)

Indicate any difficulties you have had in finding the kind of program(s) you want for you child/ren. Check all that apply. (Space below can be used for further explanation of any answers) Available space in program Hours of operation Quality of program My child has special needs Transportation (please explain below)	Awareness of available programs Child's age Distance to travel Cost of program
Other (please specify)

10. Are you aware of the following services in the area? Please also indicate whether you are interested in learning more about any of the listed categories.

	Yes	Somewhat	No	Interested in learning more
Regional School District 17 programs	*Are you aware of the following services in the area? Please also indicate whether you are interested in learning more about any of the listed categories. Regional School District 17 programs Yes	Regional School District 17 programs Somewhat	Regional School District 17 programs No	Regional School District 17 programs Interested in learning more
Husky Insurance program	Husky Insurance program Yes	Husky Insurance program Somewhat	Husky Insurance program No	Husky Insurance program Interested in learning more
Preschool/Kindergarten screenings	Preschool/Kindergarten screenings Yes	Preschool/Kindergarten screenings Somewhat	Preschool/Kindergarten screenings No	Preschool/Kindergarten screenings Interested in learning more
Public library programs	Public library programs Yes	Public library programs Somewhat	Public library programs No	Public library programs Interested in learning more
Organized play groups	Organized play groups Yes	Organized play groups Somewhat	Organized play groups No	Organized play groups Interested in learning more
Food bank	Food bank Yes	Food bank Somewhat	Food bank No	Food bank Interested in learning more
Fuel assistance	Fuel assistance Yes	Fuel assistance Somewhat	Fuel assistance No	Fuel assistance Interested in learning more
Clothing bank	Clothing bank Yes	Clothing bank Somewhat	Clothing bank No	Clothing bank Interested in learning more
Youth and Family Services of H-K programs	Youth and Family Services of H-K programs Yes	Youth and Family Services of H-K programs Somewhat	Youth and Family Services of H-K programs No	Youth and Family Services of H-K programs Interested in learning more
Park and Recreation programs	Park and Recreation programs Yes	Park and Recreation programs Somewhat	Park and Recreation programs No	Park and Recreation programs Interested in learning more
Houses of Worship	Houses of Worship Yes	Houses of Worship Somewhat	Houses of Worship No	Houses of Worship Interested in learning more
Daycare programs	Daycare programs Yes	Daycare programs Somewhat	Daycare programs No	Daycare programs Interested in learning more
Parenting classes	Parenting classes Yes	Parenting classes Somewhat	Parenting classes No	Parenting classes Interested in learning more
Preschool programs	Preschool programs Yes	Preschool programs Somewhat	Preschool programs No	Preschool programs Interested in learning more
Parent support groups	Parent support groups Yes	Parent support groups Somewhat	Parent support groups No	Parent support groups Interested in learning more
Help Me Grow	Help Me Grow Yes	Help Me Grow Somewhat	Help Me Grow No	Help Me Grow Interested in learning more
Free/reduced breakfast/lunch at schools	Free/reduced breakfast/lunch at schools Yes	Free/reduced breakfast/lunch at schools Somewhat	Free/reduced breakfast/lunch at schools No	Free/reduced breakfast/lunch at schools Interested in learning more
Care4Kids	Care4Kids Yes	Care4Kids Somewhat	Care4Kids No	Care4Kids Interested in learning more
211 INFOLINE	211 INFOLINE Yes	211 INFOLINE Somewhat	211 INFOLINE No	211 INFOLINE Interested in learning more
Birth to Three services	Birth to Three services Yes	Birth to Three services Somewhat	Birth to Three services No	Birth to Three services Interested in learning more

Other (please specify)

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Parent and Guardian Needs AssessmentExit this survey

1. Default Section

1. What is your role in Haddam-Killingworth? Check all that apply.

2. What challenges does your family face? Check all that apply.

3. What would you be interested in learning more about? Check all that apply.

4. Please rate how well the following options for programs or for obtaining information work for you and your family.

5. What time of day are you available to attend programming for children under 5 on a weekday? Check all that apply.

6. What time of day would you be available to attend programming for children under 5 on a weekend? Check all that apply.

7. What type of early care/education is your child currently enrolled in? (For each program your child participates in, please check part day or full day AS WELL AS school year only or all year long)

8. How well does your current child care/education situation fit your needs?

9. Indicate any difficulties you have had in finding the kind of program(s) you want for you child/ren. Check all that apply. (Space below can be used for further explanation of any answers)

10. Are you aware of the following services in the area? Please also indicate whether you are interested in learning more about any of the listed categories.

Parent and Guardian Needs Assessment
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