Needs Assessment Survey for Families
1.
How many children do you have between the ages of 0-12?
1-2 children
3-4 children
5+ children
2.
What are the age ranges of your children? (Select all that apply)
Infants (0-12 months)
Toddlers (1-3 years)
Preschoolers (3-5 years)
School-age children (5-12 years)
3.
Are you currently using any child care services?
Yes
No
4.
If you answered 'yes' to the above question, what type of child care do you use?
Home-based care
Center-based care
Legally-exempt care
Group-family care
After-school programs
Other (please specify)
None of the above
5.
Do you face transportation barriers when accessing child care services?
Yes
No
6.
If you answered 'yes' to the question above, please explain:
7.
How much do you typically spend on child care each month?
Less than $100
$100-$300
$301-$500
More than $500
8.
What percentage of your monthly household income is spent on child care?
Less than 10%
10-20%
21-30%
More than 30%
9.
How satisfied are you with the child care services your child(ren) receive?
Very satisfied
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
Very dissatisfied
10.
What are the most important factors in choosing a child care provider? (Select up to 3)
Cost
Location
Quality of care
Curriculum or activities offered
Safety measures
Provider's experience or qualifications
Cultural/linguistic relevance
Other (please specify)
11.
Does your child have any special needs that require specialized care?
Yes
No
12.
If you answered 'yes' to the above question, how well do you feel the child care provider accommodates these needs?
Very well
Well
Neutral
Poorly
Very poorly
N/A
13.
If you answered 'yes' to question 11, what additional resources or support would be helpful in meeting your child's needs?
14.
Do you work non-traditional hours (e.g., evenings, weekends)?
Yes
No
15.
If you answered 'yes' to the above question, do you find it difficult to access child care during these hours?
Yes
No
N/A
16.
What other child care options would be helpful for families working non-traditional hours?
17.
Does your child care provider offer services that meet your cultural or language preferences?
Yes
No
18.
If you answered 'no' to the above question, what additional services would be helpful?