Family Discussion Participant Survey

Step 1 of 3

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Thank you for joining us! Your feedback helps us to improve the services we provide to families and children. Please take a moment to respond to these questions: 

Topic

Please select the topic

Today’s discussion focused on a topic that is important to me.  

Strongly Agree

Agree

Neither agree nor disagree

Disagree

Strongly Disagree

I learned information and strategies that will help me and my family. 

Strongly Agree

Agree

Neither agree nor disagree

Disagree

Strongly Disagree

What specifically did you learn today that you plan to implement?

What would you have liked to learn more about?

What topics would you like us to address in future discussions?

What can we do to make these discussions more valuable? 

Approach

The discussion leader was caring and respectful to everyone in the group.

Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

The discussion leader was knowledgeable.

Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

The discussion leader answered questions thoroughly.

Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

Help Us Spread the Word about 211 Child Care

Have you heard of 211 Child Care?

Yes

Have you, your colleagues or families you know used 211 Child Care?

Yes

Please share 2-3 sentences about these experiences:

We would like other families to know about the help, support and resources 211 Child Care provides, and positive testimonials tell the story powerfully. May we contact you to gather more information about your 211 Child Care experience?

Yes

Would you like more information about 211 Child Care?

Yes

Please share your contact information.

Name

City/Town

Phone