JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Community Needs Assessment 24-25
Please complete this survey in regards to the PA PreK Counts Program.
Keystone SMILES Community Learning
Center Inc, would like to thank you for your support to help secure financial support for Early Childhood Education.
Please rate the topics below.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
What county do you reside in?
*
Clarion (Creative Kids, Keystone SMILES Preschool)
Jefferson (Playhouse Children's Center, Creative Gardens, LLC.)
Mercer (Sharpsville Children Learning Center)
Warren (HR Rouse Children's Center, Jefferson DeFrees Family Center)
Clearfield (Little Hands Childcare Center, Inc., Learning Tree Childcare, LLC)
Venango County (Victory Elementary)
Erie County
Other:
Which of the following best describes your relationship to preschool programs:
*
Pre-School Parent/Guardian
Grandparent
Other:
Required
EDUCATION
What level of concern for additional preschool programs do you feel there is in your community?
*
Not a concern
Somewhat concerned
Very concerned
What level of concern for additional speech and language development services do you feel there is in your community?
*
Not a concern
Somewhat concerned
Very concerned
What level of concern for additional social and emotional development services do you feel there is in your community?
*
Not a concern
Somewhat concerned
Very concerned
What level of concern for additional services that address behavioral concerns do you feel there is in your community?
*
Not a concern
Somewhat concerned
Very concerned
What level of concern for additional services that support children with special needs or disabilities do you feel there is in your community?
*
Not a concern
Somewhat concerned
Very concerned
HEALTH
What is level of concern for Available/Affordable Medical Services in your community?
*
Not a concern
Somewhat concerned
Very concerned
What is the level of concern for available/affordable dental services in your community?
*
Not a concern
Somewhat concerned
Very concerned
What is level of concern for access to vision care in your community?
*
Not a concern
Somewhat concerned
Very concerned
What is the level of concern for access to hearing care in your community?
*
Not a concern
Somewhat concerned
Very concerned
What is the level of concern for mental health services in your community?
*
Not a concern
Somewhat concerned
Very concerned
NUTRITION
What is the level of concern for more adequate food to promote healthy development in your community?
*
Not a concern
Somewhat concerned
Very concerned
What is the level of concern for more education regarding child obesity or malnutrition in your community?
*
Not a concern
Somewhat concerned
Very concerned
SOCIAL SERVICES
What is the level of concern for affordable child care for in your community?
*
Not a concern
Somewhat concerned
Very concerned
What is the level of concern for additional housing/shelter services in your community?
*
Not a concern
Somewhat concerned
Very concerned
What is the level of concern for additional transportation programs in your community?
*
Not a concern
Somewhat concerned
Very concerned
What is the level of concern for additional clothing resources in your community?
*
Not a concern
Somewhat concerned
Very concerned
What is the level of concern for additional counseling services for abuse, anxiety, etc in your community?
*
Not a concern
Somewhat concerned
Very concerned
Service Areas
Medical Services (Hospitals)
*
Serious need
Moderate need
No need at all
Medical Services (Pediatricians)
*
Serious need
Moderate need
No need at all
Access to Medical Insurance for Children
*
Serious need
Moderate need
No need at all
Public House Availability
*
Serious need
Moderate need
No need at all
Public/Private School Access
*
Serious need
Moderate need
No need at all
Churches and Communities of Faith
*
Serious need
Moderate need
No need at all
Social Service System
*
Serious need
Moderate need
No need at all
Government Services
*
Serious need
Moderate need
No need at all
Crime Prevention
*
Serious need
Moderate need
No need at all
Drug and Alcohol Concerns
*
Serious need
Moderate need
No need at all
Employment Opportunities
*
Serious need
Moderate need
No need at all
Support Services of Domestic Violence
*
Serious need
Moderate need
No need at all
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Keystone SMILES.
Report Abuse
Forms
