IMACA Early Head Start Interest Questionnaire


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* 1. What is your age?

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* 4. What is your monthly family income?

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* 6. What is your family size? (Please count yourself, your spouse if applicable and your children or foster children that you are legally responsible for)

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* 7. How many children do you have?

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* 8. How old are your children? Please select all that apply.

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* 9. Please select the choice that best describes your current employment status.

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* 11. If you are married, please select the choice that most accurately reflects your spouse's current employment status.

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* 12. If you and/or your spouse work, how many hours are your children cared for each week?

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* 13. What is the typical schedule you need childcare for? Please check all that apply.

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* 14. Which of the following best describes your child care provider?

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* 19. Do you have any other frustrations or concerns you would like to share about child care in your area?

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