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Community Agency Partner Survey 
Our Head Start/Early Head Start program is currently conducting its annual community assessment, which looks at the available local services and the services we provide to families. We are asking you to please take a minute to complete this brief survey. We appreciate your impact!  

In the last year, has your agency seen changes in the following: 

Average household income
Number of low-income families contacting your agency
Number of individuals or families slightly over your income guidelines
Number of multigenerational families you serve
Number of female head of households
Number of teen pregnancies
Number of licensed child care providers
Job availability in community
Substance misuse in community
Low-income housing availability
Transportation needs
Services you offer
Are your services free?
If No to free services: Are your fees based on income?
If Yes to income based: Do you have a sliding scale?

Thank You For Your Time!

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