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Participant Survey
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1.
Do you live in...
(Required.)
Auburn
Opelika
Lee County
Russell County
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2.
Is anyone in your household...
(Required.)
Select a response
60 years or older?
-- Select an option --
Yes
No
4 years old or younger?
-- Select an option --
Yes
No
adult with disabilities?
-- Select an option --
Yes
No
child with disabilities?
-- Select an option --
Yes
No
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3.
Did you receive any of the following services?
(Required.)
Select a response
Head Start
-- Select an option --
No
Yes - satisfied w/ service/program
Yes - somewhat met expectations
Received but did not meet needs
Early Head Start
-- Select an option --
No
Yes - satisfied w/ service/program
Yes - somewhat met expectations
Received but did not meet needs
Bus transportation for HS child
-- Select an option --
No
Yes - satisfied w/ service/program
Yes - somewhat met expectations
Received but did not meet needs
Sunshine shop
-- Select an option --
No
Yes - satisfied w/ service/program
Yes - somewhat met expectations
Received but did not meet needs
*
4.
Did you receive any of the following services?
(Required.)
Select a response
Energy Assistance
-- Select an option --
No
Yes - satisfied w/ service/program
Yes - somewhat met expectations
Received but did not meet needs
Rental Assistance
-- Select an option --
No
Yes - satisfied w/ service/program
Yes - somewhat met expectations
Received but did not meet needs
Housing Counseling
-- Select an option --
No
Yes - satisfied w/ service/program
Yes - somewhat met expectations
Received but did not meet needs
Home Maintenance
-- Select an option --
No
Yes - satisfied w/ service/program
Yes - somewhat met expectations
Received but did not meet needs
Weatherization
-- Select an option --
No
Yes - satisfied w/ service/program
Yes - somewhat met expectations
Received but did not meet needs
5.
If you were not satisfied with any service, how can we improve?
Program Services - about services listed above/overall
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6.
When working with you, did staff...
(Required.)
Select a response
Have a good attitude?
-- Select an option --
All of the time
Most of the time
Some of the time
Did not
Handle your needs professionally?
-- Select an option --
All of the time
Most of the time
Some of the time
Did not
Help you in a timely manner?
-- Select an option --
All of the time
Most of the time
Some of the time
Did not
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7.
Have the services provided...
(Required.)
Select a response
improved your living conditions?
-- Select an option --
A lot
Somewhat
A little
No
been helpful to you or your child?
-- Select an option --
A lot
Somewhat
A little
No
had a continued positive effect?
-- Select an option --
A lot
Somewhat
A little
No
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8.
Do you or have you had a child in Early Head Start or Head Start? If answered no, please skip to "Comments" section.
(Required.)
Yes
No
9.
Child or children attended...
Select a response
Head Start
-- Select an option --
Yes
No
Early Head Start - Center Based
-- Select an option --
Yes
No
Early Head Start - Home Based
-- Select an option --
Yes
No
10.
About Early Head Start/Head Start
Select a response
Do/did you feel welcome to visit the class/program at any time?
-- Select an option --
Yes
Sometimes
No
Not Sure
Do/did you get the information you need such as about program activities?
-- Select an option --
Yes
Sometimes
No
Not Sure
Does/did your child's teacher communicate with you about progress (home visits, notes, conferences)?
-- Select an option --
Yes
Sometimes
No
Not Sure
Do/did you feel your child improved in areas like sentence length, vocabulary, motor skills, etc.?
-- Select an option --
Yes
Sometimes
No
Not Sure
Have/did your child's ability to get along with and play with others improve?
-- Select an option --
Yes
Sometimes
No
Not Sure
Did the teacher provide helpful information at home and center visits during the year?
-- Select an option --
Yes
Sometimes
No
Not Sure
Did you get help setting and meeting goals to help the family?
-- Select an option --
Yes
Sometimes
No
Not Sure
Would you describe yourself as generally satisfied with EHS/HS?
-- Select an option --
Yes
Sometimes
No
Not Sure
Comments
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11.
How can we improve our programs/services?
(Required.)
*
12.
What needs do you have that are not being met?
(Required.)
*
13.
What other services are needed in our community?
(Required.)