Parent Feedback Form
Your name
County
We hope the child care information recently sent to you has been helpful. We would appreciate hearing about your child care search and your chosen child care situation. Please answer the questions below, as your response is valuable in helping us assess child care needs and issues within our community.
I. Satisfaction with the referral service
1.
Was the service helpful in your search?
Very
Somewhat
No
Not Applicable
2.
Was the information helpful?
Very
Somewhat
No
Not Applicable
3.
Was the information you received accurate?
Very
Somewhat
No
Not Applicable
4.
Are you likely to use this service again, if needed?
Very
Somewhat
No
Not Applicable
Comments:
II. Experience with child care search - any problems?
Problems?
Comments
Yes
No
Cost
Yes
No
No opening for the age of my child
Yes
No
Schedule
Yes
No
Problems with location/transportation
Yes
No
Type of care I need does not exist
Yes
No
Level of quality
Yes
No
Other, describe
III. Current child care status: have you found child care through the services you received?
Yes
No
Directly, from agency referrals
Yes
No
Indirectly, describe:
Yes
No
Used other resources
Yes
No
Still looking.
Yes
No
Kept former arrangement.
Yes
No
Child care not needed yet.
Yes
No
Stopped work/job search.
last update 10/28/03