SCSD#1 Head Start Community Assessment Survey
Head Start programs are required by federal regulations to conduct an assessment of the communities they serve. The following questionnaire will allow our program to assess certain needs in our community and address some through our Head Start program. It will also allow us to design a program that will be of the highest quality for the children and families of Sweetwater County.
Head Start is a free preschool for low income families or families with high needs. Currently we have classes in Rock Springs and Green River.
Please fill out the following questions if you have children under the age of 5. Thank you for your help!
Where do you live?
What is your family's annual income?
How many people live in your household?
What are the ages of your children? (check all that apply)
Do any of your children under 5 years old have a disability?
Are you male or female?
Marital Status
What is your highest level of education?
What is your current employment status?
If unemployed, please mark the following barriers to employment (check all that apply)
If you work or are in school, what days and hours do you work/attend school? (check all that apply)
Which preschool class options would be most helpful for your family?
Which of the following best describes your current living situation?
How many times have you moved in the past year?
What type of health insurance do you have?
If you do not have health insurance, why not?
Your answer
Are any of the following a problem for your family?
Access to health care
Availability of affordable housing
Affordable child care
Quality child care
Availability of job training
Alcohol or drug abuse
Child neglect or abuse
Domestic violence
Services for mental health
Availability or access to public transportation
Availability of jobs
Services for disabled children
Child health issues (obesity, asthma, diabetes)
Access to public assistance (WIC, SNAP, Medicaid)
Incarceration of parents
Low wages
Immigration process/citizenship
What do you believe are the top causes of poverty in our county?
Your answer
Has there been a time in the last year when you or someone in your immediate family:
Needed to see a dentist but couldn't afford it?
Needed to see a doctor but couldn't afford it?
Needed to buy medicine but couldn't aford it?
Went hungry?
Could not pay rent/mortgage?
Looked for work but could not get a job?
Lost a job?
Had your utilities turned off?
Been evicted?
Could not find a childcare provider?
Did not have transportation?
What services are you using or have you used in the past? (Check all that apply)
What services were helpful to you? Why?
Your answer
What services were not helpful to you? Why not?
Your answer
Do any of the possible barriers listed below prevent you from using any community services? If so, please mark all that apply.
Other barriers:
Your answer
Is your family in need of food or nutrition help (meal planning, shopping on a budget?)
What type of childcare do you use? (check all that apply)
Are you satisfied with your childcare provider/situation?
What are the days and hours childcare is needed? (check all that apply)
Are you able to transport your child to and from school?
If you are not able to transport your child, what resources do you have to get your child to and from school? (check all that apply)
Thank you so much for helping us with this survey! If you are interested in getting more involved, please call Head Start at (307) 352 3430.
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