InterCounty Childcare Connection


. . .a child care resource and referral program of the Middle Peninsula/Northern Neck Community Services Board of Virginia

Our Mission
Helping communities identify, access and promote quality early care and education for our children.

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Sponsor

Early Childhood Division of the Middle Peninsula/Northern Neck Community Services Board

To find out more about our sponsor, please visit their website.

Affiliations

NACCRRA | The Nation's Network of Child Care Resource and Referral

Child Care Referral Follow Up Form

InterCounty Childcare Connection wants to thank you for using our ChildNet database. Please complete the following form and return it to us. Click here for a printable version that you can fax or mail to us. For additional referrals or if you have other child care questions or needs, please feel free to call us at 804-693-9446 or toll free at 1-800-650-2128.

* Indicates a required field

ANSWER ONLY THOSE QUESTIONS APPLICABLE TO SERVICES YOU HAVE RECEIVED FROM ICCC

Name: * Client ID #:
Email Address: Date: Zip Code: *
  1. How satisfied are you with the quality of your available child care options?
     Very Satisfied  Satisfied  Somewhat Satisfied  Not Satisfied  Not sure  Does not apply
  2. How satisfied are you with the quality of the care you chose?
     Very Satisfied  Satisfied  Somewhat Satisfied  Not Satisfied  Not sure  Does not apply
  3. What type of care did you chose?
     Center  Providers Home  In My Home  Preschool program
     Friend/Relative Care  Head Start  Before and After school
     Camp  Parent's Day Out  Still looking  Decided not to use child care
     Found a program not on the list
  4. Did you have a problem finding care?
     Yes No
      If yes, please indicate reason:
       Cost  Available hours  No openings  Location  Quality  Transportation
      Other:
  5. Which of the following quality indicators do you use in choosing child care?
     Caregivers/Teachers  Activities/Curriculum  Setting/Environment  Adult/Child Interactions
    Other Indictors:

Please rate your experience with our agency staff:

  1. Courtesy and helpfulness:
     Excellent  Very Good  Good  Fair  Poor  Not Sure  Does not apply
  2. Knowledge/counseling:
     Excellent  Very Good  Good  Fair  Poor  Not Sure  Does not apply
  3. Response time:
     Same day  1-2 days  3-5 days  6-7 days  More than a week  Not Sure  N/A
  4. Accuracy of information:
     Excellent  Very Good  Good  Fair  Poor  Not Sure  Does not apply
  5. Quality of information:
     Excellent  Very Good  Good  Fair  Poor  Not Sure  Does not apply
  6. Were you able to make a better decision regarding child care based on our services and information?
     Yes  No  Not Sure
  7. Did your understanding of available resources such as financial assistance, child health insurance or other community resources for families increase?
     Yes  No  Not Sure
  8. Would you use our service again?
     Yes  No  Not Sure
  9. Would you recommend this service to others?
     Yes  No  Not Sure
  10. How did you access this service?
     Phone  Internet  Email  Fax  In person
  11. Would you be interested in being contacted for advocacy efforts? If so, please include your phone or email contact information:

  12. How could we improve our service to families?
       

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