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* 1. What County do you live in?

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* 2. What is your zip code?

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* 3. Does your family need daycare services for children under the age of five?

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* 4. Do you have reliable, affordable childcare during the day while you work or go to school?

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* 5. Does the lack of reliable/affordable childcare keep you from working or going to school?

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* 6. Do you have a child enrolled in a preschool program? What hours does he/she attend?

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* 7. Do you have a child enrolled in a birth to three home visiting program?

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* 8. Are you interested in a program that offers wrap-around services? (meaning that childcare is available before and after the Head Start program)

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* 9. Have you used the Child Care Assistance Program (CCAP) to help cover the cost of daycare?

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* 10. Would you participate in a center-based Early Head Start program for children 6 weeks to 3 years old, which provides supportive learning as well as childcare? (EHS has a requirement that you would be working or going to school).

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* 11. Does your community provide enough options for childcare for families? If not, what types of services does your community need?

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