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* 1. Contact Information

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* 2. What counties does your agency provide services for?

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* 3. In the last year, has your agency seen changes in the following:

  Increase Decrease No Change
Average household income
Number of low-income families contacting your agency
Number of multigenerational families you serve
Number of female head of households
Number of teen pregnancies
Number of licensed child care providers
Job availability in community
Substance misuse in community
Low-income housing availability
Homelessness
Transportation needs
Services you offer

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* 4. Are your services free?

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* 5. If No to Question 4: Are your fees based on income?

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* 6. If Yes to Question 5: Do you have a sliding scale based on income?

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* 7. What do you believe are your agency's and community strength's  when working with low-income families?

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* 8. What do you believe are your agency's and community's obstacles when working with low-income families?

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* 9. Are there other concerns you think are issues for our community?

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* 10. What other programs or services do you believe our Head Start and Early Head Start program could offer to better serve our community?

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* 11. Do you have suggestions about how Head Start and Early Head Start could collaborate or partner with your agency or community in order to better meet the needs of low-income children and families?

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* 12. Has your agency received new funding?

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* 13. Is your agency experiencing reduction of funding?

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* 14. Does your agency have a waiting list for services?

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* 15. Are there any major health issues facing families such as help applying for affordable health insurance, obesity, depression, substance abuse, paying for prescription medicine, etc.

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* 16. Do you work with teen mothers? Do you have teen pregnancies in your area?

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* 17. Are there any new trends or changes from the previous year in regards to children including children with special needs (disabilities, mental health, and health)?

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* 18. Is your agency experiencing hiring challenges?

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* 20. The agency’s biggest stressors or challenges for the year due to COVID-19 were:

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* 21. Due to COVID-19, how were the services for families and children affected?

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