General Information

 
8% of survey complete.

Have questions while completing this questionnaire? Please call Charity McKinney at (336) 245-4900 or e-mail at cmckinney@ccrr.org

Questions with an Asterisk (*) in front of them are required.

Can't complete all of this questionnaire at one time? That's okay! Simply re-click the link in the invitation e-mail to pick back-up where you left off.

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* In what County are you located?

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* Name of the person completing this questionnaire:

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* School-Age Program Name:

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* Director's Name:

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* Physical Location Address (please include street address, city, and zip code):

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* Mailing Address IF DIFFERENT from your location address (skip this question if your location address and mailing address are the same):

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* Primary Phone Number (Please include extension if applicable):

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* Secondary Phone Number (If Applicable):

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* Fax Number (If Applicable):

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* E-mail Address:

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* List the Following for Your Program (If Applicable):

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* What is the MAXIMUM number of children you are willing to take in your School-Age Program (Desired Capacity)?

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* How many OPENINGS/VACANCIES do you currently have available in your School-Age Program for the UPCOMING SCHOOL YEAR?

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* Please select any languages OTHER than English that you OR your staff speak (skip this question if English is the only language spoken by you or your staff):

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* Do you provide care during any of the following circumstances (SELECT ALL THAT APPLY)?

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