This survey is being conducted by the Count Me In 4 Kids (CMI4K) collaborative. We are committed to strengthening families and identifying gaps within the current offerings. Whether you are a biological parent, foster parent, adoptive parent, guardian, family member caring for a child, or other caregiver, your responses will help us achieve these goals.

All information is private and utilized strictly for the purpose of this study.

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1. In which of the following areas are you struggling or needing support as a parent or caregiver?
(Check all that apply.)

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2. Are the current resources available to serve your biological, foster, adoptive, and justice-involved children sufficient?

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3. What services do you feel are currently unavailable or hard to access for children and families?
(Check all that apply.)

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4. What difficulties have you experienced when trying to access services for your family?
(Check all that apply.)

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5. What service or program has benefitted your family, that you would like other families to know about?

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6. If you could wave a magic wand and remove any obstacle or add any service/program, what would it be?

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7. What other issues or concerns do you have as a parent or caregiver?

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8. What is your gender?

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9. What is your age?

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10. What is your race or ethnicity?

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11. How many children age 17 or younger do you care for in your home?
(If your children are currently in state custody, please indicate how many of them lived with you before they were placed outside your home.)

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12. Which of the following best describes your current relationship status?

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13. What is your 5-digit zipcode?

Thank you for sharing your thoughts with us!

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