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* 1. Have you formally and voluntarily scaled back or do you plan to scale back the hours you are working due to increased caregiver demands as a result of Covid-19? (This could mean reducing to part-time workload, assuming fewer shifts at an hourly job, volunteering to be furloughed, taking an increased number of unplanned paid days off.)

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* 2. Have you significantly flexed your working hours to include working early mornings, late evenings, or weekends in order to have more time to provide childcare or other caregiving responsibilities during your regularly scheduled working hours?

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* 3. As you consider the next 12 months of your career, will you refrain from any of the following items that you may have previously considered due to caregiver responsibilities:

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* 4. If you have a partner in caregiving, has your partner scaled back his/her/their career in order to accommodate heightened caregiver responsibilities during Covid-19?

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* 5. How confident are you regarding the safety of your family as a result of the decisions you have made for balancing caregiving and your career?

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* 6. How confident are you regarding your career trajectory as a result of the decisions you have made for balancing caregiving and your career?

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* 7. For those where remote work is an option: Did your organization formally revise or introduce policies that allowed for children to be in your home without other caregiving options during your work schedule?

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* 8. What do you most need from your organization right now to reconcile any tension between your professional aspirations and your caregiving responsibilities?

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* 9. Please provide a name and email address to provide additional feedback if there was anything not asked about that will likely affect your career advancement as a result of Covid-19 and caregiver responsibilities. 

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* 10. Is your current situation (Check all that apply):

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