MCH Childcare Needs Survey During COVID-19 Closure
Survey Questions
1.
What is your first and last name?
2.
At what email address would you like to be contacted?
3.
Please select how many children you will need childcare for in each program level.
1
2
3
4+
None
Infant
1
2
3
4+
None
Toddler
1
2
3
4+
None
Early Childhood
1
2
3
4+
None
Elementary/Middle School
1
2
3
4+
None
4.
Please select your childcare day and time needs.
Monday
Tuesday
Wednesday
Thursday
Friday
8:00-12:00 PM
Monday
Tuesday
Wednesday
Thursday
Friday
12:00-4:00 PM
Monday
Tuesday
Wednesday
Thursday
Friday
8:00-4:00 PM (All Day)
Monday
Tuesday
Wednesday
Thursday
Friday
5.
Do you work or volunteer in any of the following fields: medical/healthcare, emergency services or first responders?
Yes
No
6.
Would your financial livelihood be adversely impacted due to lack of childcare?
Yes
No
7.
Would your employment be adversely affected if you could not report to work due to lack of childcare?
Yes
No
