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* 1. Do you have children under the age of 5 in your home?

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* 2. Are you in need of full-day child care for your child?

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* 3. If your child is between 6 weeks old and 3 years old and there was FREE early educational programming offered by Early Head Start for children would you send your child?

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* 4. If your child is between 3 and 4 years old and there was FREE early educational programming offered by Head Start for children would you send your child?

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* 5. What is your marital status?

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* 6. What is your age?

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* 7. Are you currently employed?

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* 8. Are you currently going to school?

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* 9. Are you interested in furthering your education?

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* 10. Are you interested in working with young children?

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* 11. Are you in need of year-round childcare including summer?

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* 12. What is your annual household income?

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* 13. Do you receive assistance from any of the following (check all that apply)?

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* 14. In which town do you live?

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* 15. Do you have safe reliable transportation?

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