White Mountains Child Care Survey (southern Navajo/Apache counties)

Question Title

* 1. Do you have any children in your home under the age of 13?

Yes

Question Title

* 2. How many children, by age, currently live in your household?

	one	two	three	four
under one year	under one year one	under one year two	under one year three	under one year four	under one year
one year - two years	one year - two years one	one year - two years two	one year - two years three	one year - two years four	one year - two years
three years - five years	three years - five years one	three years - five years two	three years - five years three	three years - five years four	three years - five years
six - nine years	six - nine years one	six - nine years two	six - nine years three	six - nine years four	six - nine years
ten - thirteen years	ten - thirteen years one	ten - thirteen years two	ten - thirteen years three	ten - thirteen years four	ten - thirteen years

Question Title

* 3. APACHE COUNTY: Please indicate the choice closest to where you would prefer your child care to be located.

Concho/St. Johns/Sanders

Springerville/Eager/Greer

Alpine/Nutrioso

Other (please specify)

Question Title

* 4. NAVAJO COUNTY: Please indicate the choice closest to where you would prefer your child care to be located.

Snowflake/Taylor

Heber/Overgaard

Show Low/White Mountain Lake/Vernon

Pinetop/Lakeside

Pinedale/Clay Springs/Linden

Holbrook/Joseph City/Winslow/Petrified Forest

Other (please specify)

Question Title

* 5. Do you currently pay for child care for some of the children under thirteen in your household?

Yes

Question Title

* 6. Mark the boxes that reflect your paid child care arrangement(s).

I do not use paid child care

Family member at their home or yours

Other adult caregiver comes to my home

My child(ren) go to the home of an adult (non-family)caregiver

Child care/day care center (a business)

Faith based facility

Other (please specify)

Question Title

* 7. What is your total average weekly child care cost? Please choose one.

less than $100 per week

more than $100 but less than $150

more than $150 but less than $200

more than $200 per week

Question Title

* 8. Do you currently receive some kind of subsidy to help you with this cost?Multiple answers accepted.

DES

Employer assistance/ receive a discount at location my employer supports

Federal income tax - child care credit

Child care grant/scholarship

No assistance/subsidy

Other (please specify)

Question Title

* 9. For purposes of employment and transportation to/from my/our place of work or school, child care is needed ___ hours. Choose one answer.

5 - 10 hours per week

10 - 20 hours per week

20 - 30 hours per week

30 - 40 hours per week

40 - 60 hours per week

Other (please indicate specific times)

Question Title

* 10. We need childcare during ___ hours. Multiple answers accepted.

daytime hours (approx. 8am - 4pm)

evening hours (approx. 4pm - midnight)

nighttime work (approx. midnight - 8am)

weekends

on call

gap coverage - K*12 before/after school

Other (please specify)

Question Title

* 11. How many days (yearly estimate) have you been late/missed work or school due to child care issues?
(i.e. sick child, had to pick up child early, child care provider sick/closed, "snow days" closed school. You may have had to use your sick time or personal release time.)

Not applicable

1 - 3 day(s)

4 - 6 days

more than six days

Question Title

* 12. If you need child care, but are not using available options, please tell us why you are not using child care.
Examples: not available near my home, too expensive, poor quality facility where I need care

Question Title

* 13. How did you hear about this survey?

Employer

Educational institution

Friend

Medical/dental office

Church

Child care provider

Public meeting

Other (please specify)

Question Title

* 14. Thank you for your time. If you want more information, go to www.greaterthanaz.net
If you would like to contribute suggestions/solutions regarding child care needs, you may use the space below.

Question Title

* 1. Do you have any children in your home under the age of 13?

Question Title

* 2. How many children, by age, currently live in your household?

Question Title

* 3. APACHE COUNTY: Please indicate the choice closest to where you would prefer your child care to be located.

Question Title

* 4. NAVAJO COUNTY: Please indicate the choice closest to where you would prefer your child care to be located.

Question Title

* 5. Do you currently pay for child care for some of the children under thirteen in your household?

Question Title

* 6. Mark the boxes that reflect your paid child care arrangement(s).

Question Title

* 7. What is your total average weekly child care cost? Please choose one.

Question Title

* 8. Do you currently receive some kind of subsidy to help you with this cost?Multiple answers accepted.

Question Title

* 9. For purposes of employment and transportation to/from my/our place of work or school, child care is needed ___ hours. Choose one answer.

Question Title

* 10. We need childcare during ___ hours. Multiple answers accepted.

Question Title

* 11. How many days (yearly estimate) have you been late/missed work or school due to child care issues?(i.e. sick child, had to pick up child early, child care provider sick/closed, "snow days" closed school. You may have had to use your sick time or personal release time.)

Question Title

* 12. If you need child care, but are not using available options, please tell us why you are not using child care.Examples: not available near my home, too expensive, poor quality facility where I need care

Question Title

* 13. How did you hear about this survey?

Question Title

* 14. Thank you for your time. If you want more information, go to www.greaterthanaz.netIf you would like to contribute suggestions/solutions regarding child care needs, you may use the space below.

* 11. How many days (yearly estimate) have you been late/missed work or school due to child care issues?
(i.e. sick child, had to pick up child early, child care provider sick/closed, "snow days" closed school. You may have had to use your sick time or personal release time.)

* 12. If you need child care, but are not using available options, please tell us why you are not using child care.
Examples: not available near my home, too expensive, poor quality facility where I need care

* 14. Thank you for your time. If you want more information, go to www.greaterthanaz.net
If you would like to contribute suggestions/solutions regarding child care needs, you may use the space below.