1.

Did you receive names, addresses and
telephone numbers of Care for ME caregivers?

yes

no

2.

Did you choose a Care for ME Approved Caregiver
to care for you child?

yes

no

a. If NO, why not?

No openings
Location
Quality
Other:

b. If NO, what
did you do?

Found a certified provider
Found a friend or relative to provide care for a fee
Found a friend or relative to provide care for no fee
Changed my work or school plans
Other:

3.

In addition to referrals, Care for ME provides
information on choosing childcare.
Did you find this information helpful?

yes

4.

Did you receive a children's book?

yes

5.

How long did it take from the time you
made your request of the Care for ME staff,
for you to receive the information you requested?

More than a week
1 to 2 days
1 hour (emailed)
Do not remember

6.

How did you hear about the Care for ME Program?

7.

How would you rate the quality of the Care for ME services you received
in the following ways?

8.

Is there anything else you would like to tell us about
your experience with Care for ME?

Thank you for completing this survey.

Name:

Date: