CH-UH Pre-Kindergarten Community Needs Assessment Survey

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* 1. To which of the following age groups do you currently belong?

Under 18

18-24

24-34

35-44

45-54

55-65

65+

Prefer not to answer

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* 2. Which of the following do you consider to be your primary race?

White/Caucasian

Black/African American

Asian

Pacific Islander

Hispanic/Latino

Latin American

Native American/Alaskan Native

Other

Prefer not to answer

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* 3. Counting income from all sources for everyone living in your household, which category below represents your annual household income for 2015 before taxes (gross income)?

Less than $10,000

$10,000-$14,000

$15,000-$24,999

$25,000-$34,000

$35,000-$49,999

$50,000-$74,999

$75,000-$99,999

$100,000-$149,999

$150,000-$199,999

$200,000 +

Prefer not to answer

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* 4. What elementary school is considered your child's "Home School?"

Boulevard Elementary School

Canterbury Elementary School

Fairfax Elementary School

Gearity Professional Development School

Noble Elementary School

Oxford Elementary School

Roxboro Elementary School

Not Sure

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* 5. Of your children, how many are:

	1	2	3	4	5+
Pre-K Age (3-5)	Pre-K Age (3-5) 1	Pre-K Age (3-5) 2	Pre-K Age (3-5) 3	Pre-K Age (3-5) 4	Pre-K Age (3-5) 5+
Grades K-1	Grades K-1 1	Grades K-1 2	Grades K-1 3	Grades K-1 4	Grades K-1 5+
Grades 2-3	Grades 2-3 1	Grades 2-3 2	Grades 2-3 3	Grades 2-3 4	Grades 2-3 5+
Grades 4-5	Grades 4-5 1	Grades 4-5 2	Grades 4-5 3	Grades 4-5 4	Grades 4-5 5+
Gardes 6-8	Gardes 6-8 1	Gardes 6-8 2	Gardes 6-8 3	Gardes 6-8 4	Gardes 6-8 5+
Grades 9-12	Grades 9-12 1	Grades 9-12 2	Grades 9-12 3	Grades 9-12 4	Grades 9-12 5+

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* 6. Were you aware that the school district offers Early Childhood Programs for Preschool and Pre-Kindergarten?

Yes

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* 7. If you were aware of the district's Preschool/Pre-Kindergarten program, how many of your children have attended?

N/A

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* 8. If your child attended the district's Preschool/Pre-Kindergarten program, did they attend the Full Day Program or the 1/2 Day Program?

Full Day

1/2 Day

N/A

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* 9. Did your child attend the Preschool/Pre-Kindergarten program as a child with an IEP?

Yes

I have had multiple children enrolled. Some have attended with an IEP and others without

N/A

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* 10. If you were not aware of the school district's Preschool/Pre-Kindergarten programming, would you have enrolled your child if you had known that they existed? How many of your children would you have sent to the program?

	1	2	3	4	N/A
Yes	Yes 1	Yes 2	Yes 3	Yes 4	Yes N/A
No	No 1	No 2	No 3	No 4	No N/A
N/A	N/A 1	N/A 2	N/A 3	N/A 4	N/A N/A

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* 11. Does your child(ren) attend a community program (not district programming) for ages 3-5?

Yes

N/A

What community program does your child attend?

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* 12. How many of your children will be age 4 by September 30, 2017?

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* 13. How many of your children will be age 3 by September 30, 2017?

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* 14. Would you be interested in enrolling your child in the district's Full Day Preschool and/or Pre-Kindergarten programming for the 2017-2108 school year?

Yes

Unsure

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* 15. If you answered no to the previous question, will your child(ren) attend a different Preschool, Pre-Kindergarten or Daycare Program?

Yes

N/A

Please list where your child(ren) will attend?

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* 16. Would you be interested in Before & After school extended care?

Before school extended care

After school extended care

Both Before & After school extended care

No, I would not need extended care

N/A

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* 17. Transportation:

I would need district transportation for my child to attend the district's Preschool/Pre-Kindergarten programming.

I would be able to transport my own child(ren) to and from school

N/A

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* 18. How far would you be willing to travel for district Preschool/Pre-Kindergarten programming?

up to 1 mile

1-2 miles

2-3 miles

3-5 miles

5-8 miles

Anywhere in the district

I would need transportation regardless of distance