Referral Survey - Aggie Care

SECTION 1: Child Care Referral

If you have received information from Aggie CARE or Child Care Resource and Referral please complete the following section. All information is CONFIDENTIAL! We use this information to improve our processes and assist child care providers in Professional Development Training.

1. Have you used our services before?

Yes No Don't know Other:

2. How did you hear about our services?

3. What services are you currently looking for?

Other:

4. What is your present child care arrangement?

Other:

5. Did you receive a referral list of potential child care providers?

Yes No Other:

6. Did you use information from the Aggie CARE website?

Yes No Other:

7. Did you find child care?

Yes No Other:

8. If you did not find care, why?

Other:

9. What were problems for you in looking for child care?

10. Provider contact (1) List provider name is optional. All information is completely confidential.

Phone in person email Other:

11. Provider contact (1) first impressions

	very positive	positive	neutral	negative	very negative	n/a
Appearance of the outside of the home
Appearance of the inside of the home
open door policy
Where there policies clear
Hours of operations
Did you feel they addressed child safety measures

12. Provider contact (2) List provider name is optional. All information is completely confidential.

Phone in person email Other:

13. Provider contact (2) first impressions

	very positive	positive	neutral	negative	very negative	n/a
Appearance of the outside of the home
Appearance of the inside of the home
open door policy
Where there policies clear
Hours of operations
Did you feel they addressed child safety measures

14. Provider contact (3) List provider name is optional. All information is completely confidential.

Phone in person email Other:

15. Provider contact (3) first impressions

	very positive	positive	neutral	negative	very negative	n/a
Appearance of the outside of the home
Appearance of the inside of the home
open door policy
Where there policies clear
Hours of operations
Did you feel they addressed child safety measures

16. What stands out in your mind as a positive attribute you found during this process?

17. How can we better improve your experience with Aggie CARE or your potential child care provider?

	High Concern	Medium Concern	Low Concern	Not applicable
Cost
Type of care not available
No Openings
Schedule difficulties
Location
Quality
Other