We want to hear from you! Your feedback will help us understand how recent changes — like the enrollment freeze and increased co-payments — are affecting families. This survey should take less than 3 minutes to complete. All responses will remain confidential and will be used to support better child care policies in New Jersey.

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* 1. Parent/Guardian Name

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* 2. Address:

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* 3. County of Residence

Children Currently Receiving Child Care Assistance (Subsidy)

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* 4. Please check the age group(s) for each child who is currently receiving child care assistance:

  Ages Group
Child 1
Child 2
Child 3
Child 4
Child 5
Child 6
Children NOT Receiving Child Care Assistance (But Who Need It)

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* 5. Please check the age group(s) for each child who is not receiving child care assistance:

  Ages Group
Child 1
Child 2
Child 3
Child 4
Child 5
Child 6
Recent Program Changes

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* 6. Did your co-payment amount increase recently?

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* 7. How have the enrollment freeze or the increase in co-payments affected your family?

Stay Connected

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* 8. Would you like someone from Advocates for Children of New Jersey (ACNJ) to contact you?

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* 9. If yes, please provide:

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* 10. Would you like to receive ACNJ's Enews or action alerts? If so, please provide your email:

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* 11. If yes, please provide your email:

Thank you for taking the time to complete the survey. For more information contact:

Cindy Shields
Senior Policy Analyst | Early Care & Education
Advocates for Children of New Jersey
35 Halsey Street
Newark, NJ 07102
www.acnj.org
973-643-3876, ext. 216
Cell: 201-446-3092
Click here to schedule a meeting with me.

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