Please provide the following information:

1) How did you hear about the Child Care Resource Network?

Word of Mouth Posters, flyers, advertisement Media (Radio, TV, Newspaper) Office of Family and Children Services

2) Age:

18-29 30-39 40-49 50+

3) What is your highest level of education?

Some high school High school diploma Some college credits Associate's degree Bachelor's degree or higher

4) How would you describe your Race/Ethnicity?

African-American Hispanic Asian or Pacific Islander Associate's degree Caucasian Biracial/Multicultural Other

5) What is your household income?

Under $5,000 $5,000-$10,000 $10,001-$15,000 $15,001-$20,000 $20,001-$30,000 $40,000 + Other

6) Please list all your present sources of income:

Public assistance grant TANF grant Job-training grant Education grant Part-time employment Full-time employment

7) Do you presently provide care for children whose child care is subsidized by the Office of Children and Family Services?

Yes No

8) Do you wish to provide care for children whose child care is subsidized by the Office of Child and Family Services?

Yes No