SECC Survey

Family Care

The SECC Office of Institutional Planning and Research is conducting a survey of childcare needs among our students. Any information collected will be kept confidential, used only for SECC reporting purposes, and will not be made public.

 
  1. Your Age: ___
  2. Are you a ___ Full-time Student? or

___ Part-time Student?

3. Sex: ___ Male ___ Female

4. Marital Status: ___ Single ___ Married

___ Divorced ___ Separated

5. Are you employed? ___ No ___ Yes

___ Full-time ___ Part-time

6. Typical Work Schedule: (indicate hours, days, evenings)

______________________

______________________

7. Are you a parent or a caregiver for a dependent child or a family member?

___ No (stop here - thank you)

___ Yes (go on to # 8)

8a. How many dependents? _________

8b. Ages? _______________________

9a. My current family care provider is: (check all that apply)

_____ Spouse

_____ Friend

_____ Family-member

_____ In-your-home

_____ In another home (1-5)

_____ Facility care (5 or more)

9b. Cost of Family Care expense

(average weekly, in dollars) _________

10) Optional

Name______________________________

Address____________________________

Social Security # _____________________

  

Place a check-mark in the appropriate box

YES

NO

11

Have you ever had to miss class due to family care problems?

 

 

12

Have you ever had to bring your child(ren) to school in order to attend class or complete an assignment?

 

 

13

Has it taken you longer to complete your educational goals because of a lack of appropriate family care?

 

 

14

Have you ever had to avoid an important class that you needed because you couldn't find care services at that time?

 

 

15

Have you ever considered dropping out of college due to unreliable and/or unaffordable care?

 

 

16

Did you delay your educational plans until your children were old enough to attend school regularly?

 

 

17

Do you share or exchange care services with another student, friend, or a member of your immediate family?

 

 

18

If a licensed care provider were located close to your campus and open extended hours, would it be helpful to you?

 

 

19

Do you or your provider receive assistance or a cash subsidy from any source for child or family care?

 

 

20

Is your care provider trained in CPR or other emergency procedures?

 

 

21

Has your care provider received any training (specific to childhood education or elder-caring) to your knowledge?

 

 

22

On a scale of 1 (low) to 5 (high), rate your level-of-satisfaction with your current care arrangement. (Place check in one box only.)

1

2

3

4

5