Reconnect2Work Child Care Provider Needs Assessment

Child Care Provider Needs Assessment

Please share information about your program and help us learn how we can best assist you in hiring, retaining, and training employees. Your feedback will inform our program priorities in the next 3-6 months, and help us provide targeted assistance where you need it most.
Your Name*

First NameLast Name
Title
Email address*
example@example.com
Phone Number*
Please enter a valid phone number.
What is the name of your child care center?*
Address of your childcare center

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Operating hours of your childcare center*

Please select your preferred method of contact:*

EmailPhoneOther
What type(s) of center/program do you run?*

Licensed daycare centerLicensed in-home daycareUnlicensed/friends or family careBefore/After School ProgramECEAP ProgramPreschool (not ECEAP)In-home nannyOther
How many children do you provide care for currently?*
How many children are you licensed for at capacity?*
Do you offer free or reduced childcare for employees? Please answer Yes/No, if Yes please specify.*

Please help us prioritize assistance we may provide in this program:*

	High Priority	Neutral - Nice to Have	Low Priority
Help recruiting employees
Help retaining employees
Supports for employee mental health
Help training employees
Help providing healthcare and/or other employee benefits
Help navigating licensing and other state regulations and processes

Please describe any other help that you could use to stabilize your business or increase the number of childcare slots available to families.
I would be interested in no-cost, personalized assistance on hiring and retention strategies.

YesNo
What else can you tell us about the needs at your specific childcare center?
I authorize a Reconnect2Work staff member to reach out to me, using the contact information above, to assist with needs identified on this survey.*

YesNo
Should be Empty: