Pre-Survey - Head Start & Child Welfare Learning Event - 1.31.2024

Pre-Survey - Attendee Information

This pre-survey will be utilized to gather information from registrants to ensure needed accommodations are available. In addition, responses to this survey will be utilized to inform event planning and training content.

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* 1. Who is attending this event?

Name

Agency

Role at Agency

Email Address

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* 2. Please provide any food allergies/sensitivities you have so we can have accessible lunch options.

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* 3. Do you have any accommodation needs (i.e. hearing or vision impairment, parking close to the entrance, etc.)?

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* 4. Understanding the level of collaboration among key stakeholders is critical for our event. Please rate the level of partnership you experience with each of the following sectors:

Note: If you have different relationships with different providers/organizations in a category, check the option that best describes your relationship with most of them.

	No Working Relationship (little/no contact)	Cooperation (exchange info/referrals)	Coordination (work together)	Collaboration (share resources/ agreements)	N/A - I represent this sector.
Local/County Child Welfare agency (e.g., child protective services)	Local/County Child Welfare agency (e.g., child protective services) No Working Relationship (little/no contact)	Local/County Child Welfare agency (e.g., child protective services) Cooperation (exchange info/referrals)	Local/County Child Welfare agency (e.g., child protective services) Coordination (work together)	Local/County Child Welfare agency (e.g., child protective services) Collaboration (share resources/ agreements)	Local/County Child Welfare agency (e.g., child protective services) N/A - I represent this sector.
State Child Welfare Agency	State Child Welfare Agency No Working Relationship (little/no contact)	State Child Welfare Agency Cooperation (exchange info/referrals)	State Child Welfare Agency Coordination (work together)	State Child Welfare Agency Collaboration (share resources/ agreements)	State Child Welfare Agency N/A - I represent this sector.
State Children’s Trust agency (State Children's Trust & Prevention Fund (supports strategies/programs that prevent child abuse and neglect via grants, training, services, etc.)	State Children’s Trust agency (State Children's Trust & Prevention Fund (supports strategies/programs that prevent child abuse and neglect via grants, training, services, etc.) No Working Relationship (little/no contact)	State Children’s Trust agency (State Children's Trust & Prevention Fund (supports strategies/programs that prevent child abuse and neglect via grants, training, services, etc.) Cooperation (exchange info/referrals)	State Children’s Trust agency (State Children's Trust & Prevention Fund (supports strategies/programs that prevent child abuse and neglect via grants, training, services, etc.) Coordination (work together)	State Children’s Trust agency (State Children's Trust & Prevention Fund (supports strategies/programs that prevent child abuse and neglect via grants, training, services, etc.) Collaboration (share resources/ agreements)	State Children’s Trust agency (State Children's Trust & Prevention Fund (supports strategies/programs that prevent child abuse and neglect via grants, training, services, etc.) N/A - I represent this sector.
Services and networks supporting foster and adoptive families	Services and networks supporting foster and adoptive families No Working Relationship (little/no contact)	Services and networks supporting foster and adoptive families Cooperation (exchange info/referrals)	Services and networks supporting foster and adoptive families Coordination (work together)	Services and networks supporting foster and adoptive families Collaboration (share resources/ agreements)	Services and networks supporting foster and adoptive families N/A - I represent this sector.
Head Start Programs	Head Start Programs No Working Relationship (little/no contact)	Head Start Programs Cooperation (exchange info/referrals)	Head Start Programs Coordination (work together)	Head Start Programs Collaboration (share resources/ agreements)	Head Start Programs N/A - I represent this sector.

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* 5. What is working well in your partnership efforts to address the welfare/child welfare (family/child assistance) needs of children and families in your areas? Which of these efforts do you think may be helpful to others?

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* 6. Where is an opportunity for growth that you think your program would benefit most in relation to partnering between Head Start and Children's Division?

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* 7. Many local Head Start programs and children's division county offices have Memorandum of Understanding (MOU's) in place. Please attach a copy of this MOU here so that the facilitator and planners for this event may be aware of your existing partnerships.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

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* 8. Please describe any other issues or questions you may have regarding partnerships to support welfare/child welfare (family/child assistance) needs of the children and families in your program.