COVID-19 Response Needs Survey

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* 1. How are you and your family feeling? Is anyone sick? How is your family handling the extra stress?

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* 2. Have you or anyone in your family lost their job due to COVID-19? Has your income changed due to schedule changes? This will not affect your child's enrollment in Head Start.

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* 3. Do you have enough food and supplies for your family? Are you picking up meals for your child at a Decatur Public School building? Do you need anything?

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* 4. Are you able to pay your rent/mortgage for April and May? We will have more information regarding assistance with rent in the next few months, but you cannot be evicted from your home during this time.

No

Unsure

Yes

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 5. Is your landlord/bank understanding?

Yes

No

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* 6. Are you able to pay your power bill? We will have more information regarding assistance with power bills in the next few months, but your power cannot be turned off during this time.

No

Unsure

Yes

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 7. Are you working in an essential business during the shelter in place order?

Yes

No

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* 8. Where are you working and what are your typical hours? Do you have care for your child while you are working?

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* 9. Do you have any other needs at this time?

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* 10. What is your child's name and what is the best way to contact you?