Early Childhood Education
(ECE)/Head Start Program
Cripple Creek/Victor
Community Survey
November, 2004
If you have already completed
this survey, thank you. It is not
necessary to complete another survey.
Age of responder to this survey: _________________
Gender: Male
Female
Marital Status: Single(never been married) Married Separated Divorced Widowed
Area of residence (circle one)
Victor City Limits Goldfield
Rhyolite/Gillette Area Cripple Creek City limits
Cripple Creek Mountain Estates Teller 1 subdivisions Colorado Mountain Estates
4 mile community (Teller 12 area) other:________________________________
Do you have any children? (circle all that apply)
none
no longer in household
yes: number ________and
ages:___________________________________
Do you have
any children in preschool? ________
If yes, How many?______________
Where
do(es) your child(ren) attend
preschool?_____________________________________________
If
your child attends the
Head Start
Other funding source
Type of Residence:
own rent living
with friends living with relatives
living
in temporary housing (such as RV)
other?_____________________________
Primary caregiver’s (person responsible for the child
or children ,excluding child care providers) relationship to children in the
household:
parent(s)
aunt uncle grandparent other relative
non
relative foster parent Not Applicable other?_____________________________
For families with children who need or use child care: (If not, skip to the next bold question.)
How often do you need child care (mark all that applies):
Daily/weekdays (full
day)
Daily/weekdays (half day)
Weekends in order to work
Weekends in order to run errands
Evenings in order to work
Evenings in order to run errands
Once in a while
Other?____________________________________
How
far do you travel to obtain child care?__________________miles
What
type of regular child care do you have for your child when parents or
caregivers are working?
None,
I do not have any child under the age of 12
None,
12 year old sibling/babysitter (or older) takes care of younger
siblings/children
Grandparents
Other
relatives
Friends/neighbors
Daycare
center
After
school program
Home
daycare provider (non related)
None,
parents work opposite shifts
None,
parents work schedule was adjusted so that one parent is at home
Who
provides care for your child(ren) on an irregular basis or long enough for you
to run errands?
None, I do not have any child under
the age of 12
None, 12 year old sibling/babysitter
(or older) takes care of younger siblings/children
Grandparents
Other relatives
Friends/neighbors
Daycare center
After school program
Home daycare provider (non related)
None, parents work opposite shifts
None, parents work schedule was
adjusted so that one parent is at home
In your opinion, rank each of these conditions in your
residential area:
Range: 1 (inadequate) 2
3 4 5(adequate) or Not Available (NA)
Public
Transportation services_________
Child care (full day programs)________
Housing_________
Available Housing______
Safe housing_________
Energy
efficient housing _________
Family
activities________
In your opinion, are these community services
accessible in your community? Rank them on the scale of:
1 (not accessible) 2
3 4 5(very accessible)
Physical Health_____
Mental Health/Consulting services______
Adult Education______
Social Services ( i.e. food stamps, Medicaid, LEAP)_____
Emergency food (i.e. food bank)______
If you need assistance in obtaining services in any of
the above categories, where would you go?_________________________
___________________________________________________________________________________________________________
If you should leave your community, what would be the
leading cause?
_____________________________
__________________________________________________________________________________________
What would you like to see in your community:
For
children ages birth-3…? _____________________________________________________
For
children ages 4-5? __________________________________________________________
For
children ages 6-12? _________________________________________________________
For
children ages 13-17? ________________________________________________________
For
families?__________________________________________________________________
What do you consider to be the greatest need in your
community?
What do you consider to be the greatest strength of
your community?
Your monthly income covers the following expenses
(check all that apply):
Housing____
Food____
Utilities____
Transportation____
Insurance____
Child care____
Clothing____
Medical Expenses____
Usually anything our family would like to have____
If your monthly income would allow you to spend money for these needs/items/services,
mark your preferences.
Start with 1 being your most preferred and continue to
number until all of your preferences are numbered.
Toys/games for children ________
Books for children __________
Family entertainment ________
Computer/software for computers _________
Clothing __________
Babysitting for parents night out _________
Vehicle ________
Movies________
Recreational activities _________
Dinner Out_________
Upgrade housing _________
Other?:_____________________________________________________________
If Head Start offers our program to expand or to create satellite early
childhood education centers, where would you recommend the location of a center?
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
Any comments you would like to add to this survey?
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
The Early Childhood Education
(ECE) Program for the Cripple Creek/Victor School District greatly appreciates
your time in completing this survey.
Your opinions in this survey will greatly assist the ECE/Head Start
program’s effort in serving the community and our youngest citizens.
We are also in the process of
creating community focus groups to continue to study and analyze the needs and
wants of our community concerning early childhood education. If you would like to become part of this
effort, contact Patty Waddle, 689-3420.
You may mail this survey to
ECE/Head Start Program, PO Box 897, Cripple Creek, CO, 80813 or you may deliver
this survey to
Please return this survey by
November 30, 2004
Thanks again for your
assistance.