Child Care in Story County
The purpose of this survey is to gather information to see what steps need to be taken to insure that essential personnel are able to continue to perform their job duties during this outbreak of COVID-19.  The questions are specific to your full-time job and only one person in the household should complete the survey to avoid duplication of data. Thank you.
Sign in to Google to save your progress. Learn more
What category best describes your household? *
Identify which category best describes your profession.  Choose only one. *
Identify which category best describes your partners profession.  Please choose only one. *
What shift do you work? *
What shift does your partner work? *
How many children 0 - 5 will need childcare? *
How many children 6-10 will need childcare? *
How many children 11-15 will need childcare? *
How many children 16-18 will need childcare? *
I am the primary caregiver for an ill or elderly adult? *
Do any of your children have special needs? *
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms