Faculty and Staff Care Survey Faculty and Staff Care Survey Name First Last Primary Position at PitzerFacultyStaffDo you have dependents currently living at home?YesNoWhat is the age range of your child(ren)?*Check all boxes that apply for children currently living with you. Newborn (ages 0-4 weeks) Infant (ages 4 weeks-1 year) Toddler (ages 1-2 years) Preschooler (ages 2-5 years) Elementary-Aged (ages 6-12 years) Adolescent (ages 13-19) Young Adult (ages 20-24) How many Newborns do you have?12345+How many Infants do you have?12345+How many Toddlers do you have?12345+How many Preschoolers do you have?12345+How many Elementary-Aged Children do you have?12345+How many Adolescents do you have?12345+How many Young Adults do you have?12345+Do your children attend public or private school?PublicPrivateAre their classes going to be online or in person?OnlineIn-PersonWhat kind of childcare did you use prior to COVID19?Daycare FacilityAfter/Before-School ProgramIn-home ProviderRelative / FriendIs this type of childcare still an option for you?YesNoSometimes / Not surePlease explain.Do you have any special needs children?YesNoPlease explain.Do you have any other care giving obligations?YesNoTo whom do you provide care? Elderly Relative Disabled Adult Other Please explain.What kind of care did you use prior to COVID19?Senior Living FacilityIn-home Nurse/Care ProviderRelative / FriendIs this type of care still an option for you?YesNoSometimes / Not surePlease explain.What are your concerns?Please describe what your concerns may be regarding your care giving responsibilities as it relates to performing your job at Pitzer.Additional Information / Comments
