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Participation Questionnaire
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Early Childhood Family Education Participation Questionnaire
Early Childhood Family Education Participation Questionnaire
 
School Year 2011-2012
 
General Information: This questionnaire should be completed only ONE TIME per school year FOR EACH FAMILY ENROLLED in the early Childhood Family Education (ECFE) and/or the School Readiness Program. Each family is asked to voluntary provide participant information that will be used for local and state program planning and evaluation. If you do not provide this information, it will not prevent you or your child from participating in ECFE or School Readiness. Only one family member should complete this questionnaire. The information that you provide will be kept confidential and WILL NOT be directly connected with you or your family.
 
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Your Age
Your highest level of school completed
Your Current Job Status
Your Household's total yearly income, before taxes
Your racial/ethnic background of your child(ren)
Primary language spoken at home
If Other 
For Participants in ECFE ONLY
ECFE is required to serve both parents and relatives of children. Please indicate your status with regard to the child(ren) you have brought to ECFE