San Carlos Apache Tribe Early Childhood Program

Each Head Start grantee must conduct a Community Assessment within its service areas to determine whether the services they provide meet the needs of the families living in the community. This information collected in this survey is anonymous. It will only be used to demonstrate the ongoing need for Head Start, Early Head Start, and Apache Child Care within the community, and to help improve the services and programs we offer.

Thank you for participating in our survey. Your feedback is important.

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* 1. What is your family size?

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* 2. What is your current Marital Status?

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* 3. Please select a category that best describes your household:

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* 4. Are you a:

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* 5. Ethnic Information:

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* 6. What part of the community do you live in?

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* 7. Would you bring your child to one of our Centers 4 days a week?

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* 8. When do you need child care services?
(Mark any times that apply.)

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* 9. Please answer the following questions:

  Yes No
Do you work?
Are you in school?
Do you have transportation?

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* 10. Where does your annual income fall?

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* 11. Please check all services your child/children may need:

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* 12. During the last 12 months, please check any of the following resources you
have used:

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* 13. What are the ages of your children?

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* 14. Last year did your child(ren) attend?

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