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Faculty and Staff Care Survey
Faculty and Staff Care Survey
Joe Dickson
2020-08-18T12:01:12-07:00
Faculty and Staff Care Survey
Name
First
Last
Primary Position at Pitzer
Faculty
Staff
Do 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?
1
2
3
4
5+
How many Infants do you have?
1
2
3
4
5+
How many Toddlers do you have?
1
2
3
4
5+
How many Preschoolers do you have?
1
2
3
4
5+
How many Elementary-Aged Children do you have?
1
2
3
4
5+
How many Adolescents do you have?
1
2
3
4
5+
How many Young Adults do you have?
1
2
3
4
5+
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
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