Appendix B
Lesbian and Gay Child Care Task Force Needs Assessment
for Lesbian, Gay, Bisexual and Transgender Families
CODE ________
Confidential
Please check the box(es) that apply:
- Family: # of children ____ Ages ____ Hours of care each day
- Informal Provider: # of children ____ Ages ____
- Formal Provider: # of children ____ Ages ____
- Your current age: Under 21
21-30 31-40 41-50 50 or older
- Male Female
- Lesbian Gay Bisexual Transgender Heterosexual
- If you are a LGBT parent are you out to your child care provider? Yes No
- If you are a LGBT child care provider are you out to your staff and the families you serve? Yes No
- What is your ethnicity? ______________________________________________
- If you are a child care provider what are the ethnic groups you serve? _________
___________________________________________________________________
- Please describe your family structure: Co-Parent Single Parent Foster Care Family
- Blended Family (please describe) _____________________________________
- What is your yearly family income? $25,000 or under $26,000-40,000 $40,000-60,000 $60,000 or over
- Who takes care of your child? family member relative friend family home provider child care center other _______________________
- What 3 steps did you use in selecting your child's care provider?
________________________________________________________________________
________________________________________________________________________
Thank you very much for your time and willingness to be a significant part of a great effort to improve the quality of child care for all children-especially children of lesbian, gay, bisexual and transgender families.