Child Care Network of the Cape & Islands

Parent Survey Form

Dear Parent

You recently contacted Child Care Network for information on your childcare options. Thank you for contacting our agency. It is important to us that you receive quality services from our staff.

Please take a moment to complete this questionnaire so we may evaluate the Child Care Resource & Referral Program. All comments and suggestions are welcome and will remain confidential.

1. How did you hear about our services?

Dept. of Early Education & Care Child Care Provider Friend/Relative Used Service Before Website	Employer or Colleague Public School Community Fair DTA CCN Brochure
Other:

2. Did you have childcare arrangements prior to calling CCN?

Yes No

Please circle one
On a scale of 1 to 5, with 1 being the lowest and 5 the highest, please rate the following:

3. Do you feel you have an increased understanding of the child care options available to you as a result of contacting our agency?

1 2 3 4 5

4. Do you feel you have increased knowledge to help you look for a high quality program as a result of contacting our agency?

1 2 3 4 5

5. Do you feel you have increased knowledge about the financial assistance options available to you as a result of contacting our agency?

1 2 3 4 5

6. Did you find care through our service?

Yes No

7. Are you still using this provider?

Yes No

8. If your answer is yes:

How long have you used this provider? years, months

9. If your answer is no, what did you eventually do?

Found another provider
Found a friend or relative to provide care
Decided to change my work or school plans

10. What type of care are you using?

Center-based care
Family Child Care
After school care

Informal/Relative
In-home care (nanny)
Camp

11. How would you rate the childcare program/arrangements you are using?

Excellent Very Good Good Fair Poor

12. Are there any problems with your childcare arrangements?

Cost Location Quality Unavailability
Other

13. Would you recommend our service to a friend or use us again?

Yes No
Explain

14. What was your overall impression of Child Care Network?

Excellent Very Good Good Fair Poor

15. Please write any suggestions or ideas that you feel might help us serve you better in the future:

Optional:

First Name:		Last Name:
Address:		PO Box:

City:

State:

Zip Code:

Home Phone:

Work Phone:

Email: