Head Start Family Voices Pilot Study

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ATTACHMENT A6
STAFF QUESTIONNAIRE
OMB No:
Expiration Date:


Head Start Family Voices Pilot Study
Staff Questionnaire
Spring 2013




MPRID:
|     |     |     |     |     |     |
Interviewer ID:
|     |     |     |     |     |
Date Completed:
|     |     | / |     |     | / |  2  |  0  |  1  |  3 |
 Month        Day               Year

















ABOUT THIS SURVEY

    • This questionnaire is an important part of a larger study Mathematica Policy Research is conducting for the Administration for Children and Families, U.S. Department of Health and Human Services. The overall purpose of the Head Start Family Voices Pilot Study is to better understand the experiences and engagement of families participating in Head Start and Early Head Start. Participation in this project is voluntary. 
    • Most of the questions can be answered by placing an “X” or a “” in the box. For a few questions, you will be asked to provide a brief response.
   or    
|  0  |  2  | YEARS

    • If you are unsure how to answer a question, please give the best answer you can.
    • The information you provide will be used for research purposes only and will remain private to the extent allowed by law. No one from your program will see your individual responses, and your name will not be attached to any information you give us.



A1.	What is your current job position or title?
	1	□	Home Visitor, Home Educator, or Home-Based Teacher
	2	□	Family Services Staff
		Please specify your title:
				__________________________

A2.	How many families are currently in your caseload?

	|     |     |  NUMBER OF FAMILIES


A3.	Do you provide services to children and families enrolled in…
		MARK ONLY ONE
	1	□	Early Head Start only,
	2	□	Head Start only, or
	3	□	Both Early Head Start and Head Start


A4.	How many years have you been working in Head Start or Early Head Start in any position?

	|     |     |  NUMBER OF YEARS


A5.	How many years have you been working in Head Start or Early Head Start in your current position?

	|     |     |  NUMBER OF YEARS


A6.	How many years have you been working for this Head Start or Early Head Start program?

	|     |     |  NUMBER OF YEARS


A7.	Have any of the children living in your household attended Early Head Start or Head Start, either currently or in the past?
	MARK ALL THAT APPLY
	1	□	Yes, my child(ren) currently attend the program
	2	□	Yes, my child(ren) attended in the past
	3	□	No children in my household have ever attended the program
B1.	Are you…
	1	□	Male?
	2	□	Female?
B2.	In what year were you born? 
	|  1  |  9  ||     |     |  YEAR OF YOUR BIRTH
B3.	Are you of Spanish, Latino, or Hispanic origin? 
	MARK ONLY ONE
	1	□	Yes
	0	□	No


B4.	What is your racial background?
	MARK ALL THAT APPLY
	1	□	White
	2	□	Black/African American
	3	□	Asian	
	4	□	Native Hawaiian or other Pacific Islander
	5	□	American Indian/Alaska Native
	6	□	Other (Specify): 	

B5.	What is the highest grade or year of school that you have completed? If you are still in school, please tell us about the last year of schooling you completed.
	MARK ONLY ONE
	1	□	Less than high school diploma or GED certificate
	2	□	High school diploma or GED certificate
	3	□	Some technical/vocational school, but no diploma
	4	□	Technical/vocational diploma
	5	□	Some college courses, but no degree
	6	□	Associate’s degree (two-year college)
	7	□	Bachelor’s degree (four-year college)
	8	□	Master’s degree (M.A., M.S.)
	9	□	Doctorate degree (Ph.D., Ed.D.)
	10	□	Professional degree after Bachelor’s degree

B6.	In what field did you obtain your highest degree?
MARK ONLY ONE                                                                                           
	1	□	Child development or developmental psychology
	2	□	Psychology (other than developmental)
	3	□	Social work
	4	□	Sociology
	5	□	Early childhood education
	6	□	Elementary education
	7	□	Special education
	8	□	Bilingual education 
	9	□	Other field (Specify): 	
                  
B7.	Do you speak any language other than English?
	MARK ONLY ONE
	1	□	Yes
	0	□	No 

B7a.	What other languages do you speak?
MARK ALL THAT APPLY
	1	□	Spanish
	2	□	Chinese (Cantonese, Mandarin)
	3	□	Vietnamese
	4	□	a Filipino language
	5	□	Japanese
	6	□	Korean
	7	□	American sign language
	8	□	Other (Specify): ____________________________________
B8.	Which of the following categories best describes your annual household income? This includes the total combined income of all members of your household from all sources before taxes and other deductions.
	MARK ONLY ONE
	1	□	Less than $10,000
	2	□	$10,000 to less than $15,000
	3	□	$15,000 to less than $20,000
	4	□	$20,000 to less than $25,000
	5	□	$25,000 to less than $35,000
	6	□	$35,000 to less than $50,000
	7	□	$50,000 to less than $75,000
	8	□	$75,000 to less than $100,000
	9	□	$100,000 or more
Thank you very much for your help! If you have any questions about this questionnaire or the Head Start Family Voices Pilot Study, please contact Felicia Hurwitz at Mathematica Policy Research at 609-945-3379.
Please return this questionnaire to the Mathematica staff who conducted your interview, or mail it in the provided envelope to:
Mathematica Policy Research
Attn: Felicia Hurwitz – Project 40150
P.O. Box 2393
Princeton, NJ 08543-2393