Faculty and Staff Care Survey Faculty and Staff Care Survey Name First Last Primary Position at PitzerFacultyStaffDo you have dependents currently living at home? Yes No What 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? Public Private Are their classes going to be online or in person? Online In-Person What kind of childcare did you use prior to COVID19? Daycare Facility After/Before-School Program In-home Provider Relative / Friend Is this type of childcare still an option for you? Yes No Sometimes / Not sure Please explain.Do you have any special needs children? Yes No Please explain.Do you have any other care giving obligations? Yes No To whom do you provide care? Elderly Relative Disabled Adult Other Please explain.What kind of care did you use prior to COVID19? Senior Living Facility In-home Nurse/Care Provider Relative / Friend Is this type of care still an option for you? Yes No Sometimes / Not sure Please 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
