Family Survey 2021

Thank you for participating in the Lewis-Clark Early Childhood Program's Community Assessment Survey.
Your input is vital in helping us assess the needs of families and how we can better meet them through our program. 

Are you satisfied with your current level of education?
Are you interested in furthering your education?
Are you employed?
If yes, are you satisfied with your job?
Does your income allow you to meet your family's basic needs?
If no, are you seeking employment?
Do you rely on community resources to meet your family's needs?

The following three questions apply to those who have been effected by the minimum wage increase.  

Have you lost benefits due to the minimum wage increase?
Have you lost benefits due to the loss of hours due to the minimum wage increase?
Have you lost benefits due to increased income?
Washington Employment Only
Other Licensed Facilities
Do you have children who attend a licensed day care facility other than Head Start?
If yes, which of the following applies to your family?
Do you have children who use child care services other than a licensed day care?
If yes, which of the following do you use?
Other Childcare Services
Define your family's health care:
In the past year, have you had problems accessing health care?
In the past year, has any member of your family received Medicaid or State health benefits?
In the past year, has anyone in your family been physically or emotionally abused?
In the past year, which services has your family received? (check all that apply)
Do you believe you are well informed about your child's nutritional needs?
Are you able to provide nutritious meals?
Health and Nutrition
If yes, were you able to get help in your community?
Which option applies to your housing?
Is you housing adequate for your family's needs? (electricity,plumbing,heating/cooling)
Are you aware of community resources available to help find appropriate housing, if needed?
Do you have difficulty managing your financial resources to meet your family's needs?
Are you aware of financial resources in your community that might help you manage your finances?

Please indicate what effects, in the past year, the economy has had on you and your family's lifestyle and living expenses: 

Housing and Finance
You or a family member have lost employment.
Hours of work have been reduced.
You or a family member have experienced significant depression.
You or a family member have experienced excessive anxiety.
Relationships have changed (separation,divorce, etc.)
Choose to delay having another child.
Housing change/loss (forced to move)
Forced to move in with family members or friends.
Utility usage reduced or disconnected.
Delaying paying bills.
Avoided or delayed seeking medical care?
Avoided/delayed dental care?
Received assistance from food/clothing banks.
Gave up pets from your home.
Stopped/limited driving a personal vehicle.
Unable to afford auto repairs or maintenance.
Discontinued auto insurance.
Limited child's Head Start attendance.
Sought help with money management.
Increased use of credit.
More frequent use of: payday/title loan/pawn shops.
Resorted to or considered criminal activity in order to support your family. (minor theft, poaching game, dealing drugs, etc.)
Increased gambling.
Changed drinking,smoking,entertainment habits.
Spouse left family to find work in another community/state.
Please identify what social service programs you have used in the past year: (check all that apply)
From the list below, please identify three community resources that are currently strengths in your community.
Community Information

Do you feel that you or members of your family have been discriminated against in your community regarding the following characteristics: 

Education Level
Income Level
Life Style
Political Beliefs
Race or Ethnicity
Sexual Preference
Marital Status
Disability of other Physical Characteristics.
Are you satisfied with the child care your child/children receive?
Are you satisfied with the opportunities available to children in your community?  (Examples: recreational programs, after school programs, boys and girls club, etc.)
How satisfied are you with the services you receive from Lewis-Clark Early Childhood Program?

Thanks for submitting!