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COVID-19 NEEDS ASSESSMENT
Information will be confidential unless you want to be contacted on child care openings and options in Republic County.
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Contact Information if you want to receive updates on openings and options in the county.
Your answer
Have you experienced any challenges with securing child care?
Yes
No
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If yes, please describe your current situation.
Your answer
How many children do you have?
Your answer
What ages are your children?
Your answer
If child care were available, what shift would best meet your needs for those services?
Your answer
What city do you live in, or nearest to your home?
Your answer
If you are employed, what is your current shift?
Day shift
Evening shift
Night shift
Other:
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Are you at risk of being laid off?
Yes
No
Maybe
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Do you have the ability to work from home?
Yes
No
Maybe
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Does your employer give you the opportunity to work from home?
Yes
No
Maybe
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Optional: Who is your current employer?
Your answer
Would you or anyone you know be interested in providing child care services? If yes, provide name and contact information.
Your answer
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