Page 102 - PROGRAM IMPACT AND SATIFACTION AS SEEN THROUGH THE EYES OF HEAD START PARENTS

FIGURE 35: Head Start End-of-the-Year Parent Survey – English Version
Questions about You 1. I identify as:
HEAD START END-OF-THE-YEAR PARENT SURVEY Program Year 2013-2014
 Male  Female  Other: ______________________  I prefer not to respond. 2. My relationship to the Head Start child is:
 I am the Parent  I am the Legal guardian  I am the Foster parent  I am the Grandparent
Questions about Child Care, Health Care, Resources and Services 3a. I need child care.
 Yes (Continue to 3b.)  No (Skip to Question 4a.)
 Other: __________________________
 I don’t know. (Skip to Question 4a.)
3b. My child care needs are: (Check ALL that apply.) FOR MY HEAD START CHILD
 Help paying for child care  Full day
 Night
 Before or after Head Start
FOR OTHER CHILDREN IN MY FAMILY
 Help paying for child care  Full day
 Night
 Before or after Head Start
 Child care now or in the next six months
 Child care now or in the next six months
 Services for children with special needs
 Services for children with special needs
 Part day
 Part day
 Weekend
 Weekend
4a. In the last 12 months, I sought treatment at a hospital emergency room (ER) or urgent care for my Head Start child.
 Yes (Continue to 4b.)  No (Skip to Question 5.)  I don’t know (Skip to Question 5.)
4b. In the last 12 months, I sought treatment for my Head Start child at an ER or urgent care for the following: (Check ALL that apply.)
 Cough  Infection (ear, eye, skin, etc...)
 Fever  Stomach-related illness
 Other: _____________________________________________________________________________
 Allergic reaction or Poisoning
 Flu
 Difficulty breathing or Asthma
 Injury or Deep cut or wound
5. I have medical insurance for myself. Yes No
6. In the last 12 months, I received dental services for myself. Yes No
CCRC’s Head Start Parents December 2014
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