Even though you may not need child care, or may not have children under age 13, we ask that all parents in our community complete these first few questions.

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* 1. Do you currently have any children 12 and under living at home?

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* 2. How many of your children are in each of the following age groups? (please indicate the number in each age group)

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* 3. This question is about your MAJOR occupational situation - what you spend most of your time doing. Are you now or do you plan within the next year to be: 

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* 4. Generally describe your work.

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* 5. What is your annual family income before taxes are deducted?

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* 6. If you had access, at a fee you were able to pay, to your choice of child care arrangements for your child, which three would you choose? Please rank your top three choices.

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* 7. Which three of the following child care services would you most like to have offered in our community (i.e. services that don't exist or are not sufficiently available now)? Please rank your top three choices.

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* 8. Would you accept paid employment outside your home, work on your farm or go to school if adequate child care services were more available and affordable in your community?

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* 9. Who provides most of the child care for your child/children?

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* 10. How much do you pay in total per week for child care per child?

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* 11. How many hours per week do you pay for child care?

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* 12. Would you be willing and able to pay higher fees than you currently are paying to have more satisfactory child care arrangements?

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* 13. IF YES, how much would you be willing and able to pay per week for convenient, good quality child care for one child?

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* 14. Are your child care fees subsidized by the government?

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* 15. IF YES, what amount are you responsible for paying per week?

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* 16. Where would you most prefer to have child care located?

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* 17. How many minutes from your home would you be willing to have a child travel each day to a main child care arrangement?

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* 18. If we have questions on your survey or you would like updates, please provide your contact information.

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