Exit Ensure affordable available childcare and identify potential gaps for families. Question Title * 1. What is your age? 18-24 25-34 35-44 45-54 55-64 65+ Question Title * 2. In what ZIP code is your home located? (enter 5-digit ZIP code; for example, 00544 or 94305) Question Title * 3. If applicable, what school district are you in? Question Title * 4. Which of the following categories best describes your employment status? Employed, working full-time Employed, working part-time Not employed, looking for work Not employed, NOT looking for work Retired Disabled, not able to work Question Title * 5. If unemployed, is the lack of childcare or the affordability of childcare an obstacle in finding employment? Yes No Question Title * 6. What kind of business or industry best describes your employer? (For example, construction, hospital, manufacturing, distribution, education, etc.) Question Title * 7. What is your position within the company? Question Title * 8. Do you work shift work? Yes No Question Title * 9. What shifts? 1st 2nd 3rd Swing Shifts Question Title * 10. Please check the age range of your child(ren). Check all that apply. 2 and under 3-5 6-11 Question Title * 11. Which best describes your childcare provider? In Home Childcare Business/Organization Friend/Family Member Other (please specify) Question Title * 12. If you have childcare, what is the distance you travel from your place of employment to your childcare provider? 0-5 miles 6-10 miles 11-20 miles 21-30 miles More than 30 miles Question Title * 13. Have you or do you find it difficult to find childcare? Yes No Question Title * 14. Do you find it difficult to find childcare for any of the following? Check all that apply. Snow days After school Summer School holidays Shift work None of the above Other (please specify) Question Title * 15. How often have you experienced any of the following as a result of having a childcare issue? Please check all that apply. Never Sometimes Often Missed a day of work Missed a day of work Never Missed a day of work Sometimes Missed a day of work Often Been late to work Been late to work Never Been late to work Sometimes Been late to work Often Reduced regular work hours Reduced regular work hours Never Reduced regular work hours Sometimes Reduced regular work hours Often Took personal time off Took personal time off Never Took personal time off Sometimes Took personal time off Often Been distracted at work Been distracted at work Never Been distracted at work Sometimes Been distracted at work Often Been unproductive at work Been unproductive at work Never Been unproductive at work Sometimes Been unproductive at work Often Changed from full-time to part-time work Changed from full-time to part-time work Never Changed from full-time to part-time work Sometimes Changed from full-time to part-time work Often Had to leave the position Had to leave the position Never Had to leave the position Sometimes Had to leave the position Often Question Title * 16. Do you believe you have reliable and safe childcare? Yes No Question Title * 17. Have you or do you find it difficult to find affordable childcare in Halifax County? Yes No Question Title * 18. Are you aware of or do you receive childcare funding assistance? Yes No Question Title * 19. What are you paying now for childcare weekly per child? Less than $80 weekly $81-$100 weekly $101-$200 weekly Over $200 weekly Other (please specify) Question Title * 20. What do you consider a fair price to pay for childcare weekly per child? Less than $80 weekly $81-$100 weekly $101-$200 weekly Over $200 weekly Other (please specify) Question Title * 21. What is the maximum you are able to afford for childcare weekly per child? Less than $80 weekly $81-$100 weekly $101-$200 weekly Over $200 weekly Other (please specify) Question Title * 22. Please indicate how important it is for Virginia to make investments and pass childcare policies to address the issues below. Please rate 1-3, with 1 being most important and 3 being least important. 1 2 3 Making childcare more affordable for parents 1 2 3 Increasing the supply of childcare 1 2 3 Improving the quality of childcare Question Title * 23. Please describe your most significant issue or concern regarding your childcare needs. Done
