APPENDIX B5.b
PROGRAM EXPERIENCES SURVEY VERSION B (INFANT/CHILD) - ENGLISH
INTRO: Hi. Thanks for agreeing to do this survey. Your answers are private. None of the information you share with me will cause your WIC benefits to change. The questions I am going to ask are about your satisfaction and experiences with your child’s participation in WIC. Please answer as honestly as possible. This takes about 30 minutes. After we finish, I will confirm your address so I can send a $25 Visa debit card to thank you for your participation.
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0584-XXXX. The time required to complete this information collection is estimated to average 30 minutes (0.50 hours) per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: U.S. Department of Agriculture, Food and Nutrition Services, Office of Policy Support, 3101 Park Center Drive, Room 1014, Alexandria, VA 22302, ATTN: PRA (0584-xxxx*). Do not return the completed form to this address.
Q1. Let’s begin by talking about your child’s experience with WIC. Is this the first time you’ve received benefits for your child, or has your child participated before this time? [CHECK one]
NEW TO WIC [GO TO Q6]
PARTICIPATED BEFORE [CONTINUE]
Q1A. How old was your child when he/she first started getting WIC?
At birth [go TO Q7]
(# of) Months (0 to 23 months) [go TO Q7]
(# of) Years (24 months or more) [go TO Q7]
Q6. Why didn’t your child participate before this? [DO NOT READ; CHECK all that APPLY]
THIS IS MY FIRST CHILD/PREGNANCY
DIDN’T LIVE IN USA
DIDN’T KNOW ABOUT WIC
DIDN’T TRUST WIC
DIDN’T THINK MY CHILD WAS QUALIFIED FOR WIC
INQUIRED BUT WAS TOLD DIDN’T QUALIFY
APPLIED AND DID NOT QUALIFY
LACK OF TRANSPORTATION TO CLINIC, TRANSPORTATION DIFFICULTIES
SCHEDULE DIFFICULTIES
SERVICES (INCLUDING WAITING TIME) TAKE TOO MUCH TIME
WAITING SPACE AT CLINIC IS LIMITED
LACK OF CHILD CARE
LANGUAGE BARRIERS
PROBLEMS QUALIFYING FOR BENEFITS
DIFFICULTIES KEEPING APPOINTMENT TIMES
NEGATIVE SHOPPING EXPERIENCES WHILE USING WIC BENEFITS
WIC FOOD SELECTION NOT DESIRABLE
WIC FOOD STORES NOT CONVENIENT (HOURS OR LOCATION)
WIC FOOD HARD TO FIND ON SHELVES (BRANDS, QUANTITIES)
DIDN’T WANT TO PARTICIPATE IN A FOOD ASSISTANCE PROGRAM BECAUSE OF THE STIGMA
CONCERNS WITH CITIZENSHIP
DIDN’T THINK MY CHILD NEEDED IT
OTHER: PLEASE SPECIFY
NOT SURE
REFUSED
Q7.
Would your child have joined the program earlier if you and your
child had more information available?
[CHECK
one]
YES [CONTINUE]
NO [GO TO Q8]
NOT SURE [GO TO Q8]
NOT APPLICABLE [GO TO Q8]
REFUSED
Q7A. Can you tell me what kind of information or assistance would have helped? ________________________________________________________
Q8. [IF Q1=2 (PARTICIPATED BEFORE)] When did your child most recently participate in WIC and receive benefits? Can you tell me the year? Can you tell me the month?
________ YEAR
________ MONTH
NOT SURE
REFUSED
Q8A. Why did your child leave the WIC program? PROBE: Anything else?
___________________________________
Q9. Was your child still eligible for WIC when he/she left the program? [CHECK one]
YES [CONTINUE]
YES, BUT RESPONDENT INDICATED THEIR CHILD LEFT PROGRAM INVOLUNTARILY [GO TO Q11]
NO [GO TO Q11]
NOT SURE
REFUSED
Q10. What could WIC have done to encourage you to keep your child in WIC? [CHECK ALL THAT APPLY] PROBE: Anything else?
PROGRAM
HELP UNDERSTANDING PROGRAM RULES
BETTER INFORMATION ON WIC BENEFITS OR SERVICES AVAILABLE
BETTER INFORMATION ON HOW TO RECEIVE BENEFITS IF YOU MOVE TO A NEW CITY OR STATE
LESS PAPERWORK
CLINIC
LESS TIME IN WAITING ROOM
MORE CHILD PLAY AREAS OR TOYS IN THE WAITING ROOM
LESS CROWDED OFFICE
MORE LOCATIONS
CLOSER TO PUBLIC TRANSPORTATION
APPOINTMENTS
BETTER SCHEDULING OPTIONS (EXAMPLE: LUNCHTIME OR EVENING/WEEKEND APPOINTMENTS)
FEWER APPOINTMENTS
SHORTER APPOINTMENTS
FEWER DAYS SPENT WAITING BEFORE A SCHEDULED APPOINTMENT
STAFF
APPOINTMENTS WITH THE SAME WIC NUTRITION PROVIDER OR WIC STAFF
BETTER STAFF (EXAMPLE: FRIENDLIER STAFF)
MORE STAFF THAT SPEAK MY LANGUAGE
MORE STAFF UNDERSTAND MY CULTURE
SHOPPING
MORE POLITE/SENSITIVE CASHIER IN STORES
MAKE IT EASIER TO FIND WIC-APPROVED FOODS IN GROCERY STORES
MAKE IT FASTER TO USE WIC BENEFITS IN GROCERY STORES
MAKE IT MORE PRIVATE TO USE WIC BENEFITS IN GROCERY STORES
OTHER: ________________________
Q10A. Could WIC have done anything differently with the program itself, clinic, appointments, staff, or shopping that would have helped to keep your child in the program?
_______________________________________________________________________________
Q11. [if Q1=2] Why did you re-enroll your child in the WIC program at this time?
____________________________________________________________________________________
Q12. Thinking about specific qualities or characteristics of your clinic, how would you rate the [INSERT FROM BELOW]? Would you say you are Very Satisfied, Somewhat Satisfied, Neither Satisfied nor Dissatisfied, Somewhat Dissatisfied, or Very Dissatisfied? [REPEAT SCALE UNTIL R. LEARNS IT] PROBE: Please explain why you chose [respondent’s response choice]?
Very Satisfied----Somewhat Satisfied----Neither Satisfied nor Dissatisfied -----Somewhat Dissatisfied ------Very Dissatisfied [ROTATE START POINT]
Customer service or friendliness of the WIC staff
Quality of service you get
Helpfulness of the staff
Staff’s ability to speak your language
Safety of the clinic’s location
Convenience of the clinic’s location for you
Amount of time you wait until you are seen by WIC staff
The way WIC staff handles certification
The total amount of time you spend at the clinic
The amount of time it takes to be certified
Q13. Which services offered through WIC do you currently use, or have ever used?
Nutrition education
Breastfeeding promotion and support
Breastfeeding peer counseling
Referrals to other services
Monitoring weight, height, blood, and other body and health measures
Q13A. How would you rate the [INSERT FROM BELOW the services selected from q13]? Would you say it is Excellent, Very Good, Good, Fair or Poor? [REPEAT SCALE UNTIL R. LEARNS IT]. If your clinic does not offer a service, you have not used the service, or you are unsure of whether your clinic offers a service, please let me know.
Excellent-----Very Good------Good------Fair------Poor -----NA [ROTATE START POINT]
Nutrition education
Breastfeeding promotion and support
Breastfeeding peer counseling
Referrals to other services
Monitoring weight, height, blood, and other body and health measures
Q14. Were you provided with a
list of nearby places you could go to get information on
health-related and public assistance programs besides WIC, or made
aware that such lists were available?
[CHECK
one]
YES
NO
NOT SURE
REFUSED
Q15. Thinking about your experience in the program, what have you gained by being in WIC? [DO NOT READ. Check all that apply.] probe: Anything else? (meeting other people like me; learn ways to save money; learn more about health and nutrition)
Meeting and talking with other mothers
Saving money on grocery bills
Receiving links to health services
Getting nutrition information
Getting height and weight checks to know how my child is growing
Receiving advice from WIC staff
Receiving WIC benefits for foods I know are nutritious
Staying on time with shots for my child
Learning the foods my baby needs to be healthy
Learning about the foods my children need to be healthy
Learning about the foods I need to be healthy
Having breastfeeding support and education
Other: PLEASE SPECIFY: ___________________________
NOT SURE
REFUSED
[FI will predeterminE if WIC participant Lives in a state where WIC Farmers' Market Nutrition Program is offered.]
Q16. Do you participate in the WIC Farmers' Market Nutrition Program? [CHECK one]
YES [CONTINUE]
NO [GO TO Q16C]
NOT SURE
REFUSED
[not offered in participant’s state; [GO TO Q17]
Q16A. How would you rate the Farmers’ Market Nutrition Program? Would you say it is . . .[CHECK one]
Excellent
Very Good
Good
Fair
Poor
NOT SURE
REFUSED
Q16B. Please explain why you rated the Farmers’ Market Nutrition Program as [insert response from Q16A]. ________________________________________________________
Q16C. Is there any reason that you don’t participate in the WIC Farmers’ Market Nutrition Program (FMNP)? [CHECK one]
Don’t know about the program
Don’t like the foods the FMNP offer
Don’t have the transportation to get there
OTHER: PLEASE SPECIFY _________________________________
NOT SURE
REFUSED
Q17. How do you usually get to the WIC clinic when you need to go there? [do not read. check all that appLy.]
PERSONAL CAR
TAXI
UBER/LYFT
BUS
LIGHT RAIL/SUBWAY/COMMUTER TRAIN
WALK
BIKE
GET A RIDE FROM SOMEONE
OTHER: PLEASE SPECIFY ________________________________________
NOT SURE
REFUSED
Q17B. On average, how long does it take you to get to the WIC clinic using [SHOW Q17 ANSWER(s)]?
HOURS ____ MINUTES ____
NOT SURE
REFUSED
Q18. Now, think about benefits that you receive for your child that relate to food. Using the scale: Good, Fair or Poor. How would you rate the food benefits for . . .
Good------Fair ------Poor [ROTATE START POINT]
Providing the right amount of food for your child/ren?
Offering foods that your child likes to eat?
Offering nutritious foods?
Q19. Are there certain WIC foods that, on a regular basis, you do not purchase for your child for some reason? [CHECK one]
YES [CONTINUE]
NO [GO TO Q20A]
NOT SURE
REFUSED
Q20. Which ones do you not purchase? [DO NOT READ LIST. CHECK ALL THAT APPLY. FOR EACH ONE CHECKED, ASK:] Why not? [AFTER R. ANSWERS, ASK] Anything else?
ITEMS NOT PURCHASED |
Why don’t you purchase them? [CODE OR WRITE IN MAIN REASON] |
PRECODES
1–Dislike, don’t like 2–Not accustomed to eating it (including cultural differences) 3–Food allergies
4–Don’t
know how to prepare coupons
8–Store
did not have item in stock 10 Don’t think it’s a healthy food
11
Options for this are low quality
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Q20A. When making a decision to buy a certain food with your WIC benefits for your child, how important are the following:
Very
Important Slightly Important------Not At All Important
[ROTATE
START POINT]
Taste
Price
Nutritional content
Brand name in store
Availability in store
Coupon for WIC food item
Size of food package
Q21. For food items you did purchase, was there too much of any food for your child? [CHECK one]
YES [ASK: WHICH FOODS?]
NO [GO TO Q22]
NOT SURE
REFUSED
[DO NOT READ. CHECK ALL THAT APPLY]
Q21A. TOO MUCH OF WHICH FOODS? |
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Q22. For food items you did purchase, was there too little of any food for your child? [CHECK one]
YES [ASK: WHICH FOODS?]
NO [GO TO Q23]
NOT SURE
REFUSED
[DO NOT READ. CHECK ALL THAT APPLY]
Q22A. TOO LITTLE OF WHICH FOODS? |
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Q23. Which one of the following types of stores best describes where you most often use your child’s WIC benefits? [READ FULL LIST. Select only one]
Large chain grocery store or supermarket
Small individually owned grocery store
Convenience store
Tribal store or trading post
Specialty food store, such as one that specializes in ethnic foods
Store that carries only WIC-approved items
Large combination food-store retailer such as a Walmart or Target
Military commissary
Milk man delivers
[DON’T READ] OTHER [ASK: Can you describe it for me? AND TYPE BRIEF DESCRIPTION]
NOT SURE
REFUSED
Q24. Using the scale of Excellent, Very Good, Good, Fair, or Poor that we used earlier, what overall rating would you give the store where you do most of your child’s WIC shopping? [CHECK one]
EXCELLENT
VERY GOOD
GOOD
FAIR
POOR
NOT SURE
REFUSED
Q25. Do you buy WIC items at the same store where you do most of your other food shopping? [CHECK one]
YES [GO TO Q27]
NO [CONTINUE]
NOT SURE
REFUSED
Q26. Why not? [DO NOT READ. CODE ANSWER ALL THAT APPLY]
EXPENSE: WIC STORE MORE EXPENSIVE, REGULAR STORE LESS EXPENSIVE
EXPENSE: REGULAR STORE MORE EXPENSIVE, WIC STORE LESS EXPENSIVE
TRANSPORTATION: WIC STORE LESS CONVENIENT TO GET TO, REGULAR STORE MORE CONVENIENT
TRANSPORTATION: REGULAR STORE LESS CONVENIENT TO GET TO, WIC STORE MORE CONVENIENT
COURTESY: WIC STORE NOT CUSTOMER-FRIENDLY, REGULAR STORE FRIENDLIER
COURTESY: REGULAR STORE NOT CUSTOMER-FRIENDLY, WIC STORE FRIENDLIER
REGULAR STORE DOES NOT PARTICIPATE IN WIC PROGRAM
REGULAR STORE DOESN’T CARRY RIGHT SIZES/SELECTIONS OF WIC FOODS
OTHER (PLEASE SPECIFY): ___________________________
NOT SURE
REFUSED
Q27. I am going to give you a list of reasons why some people choose a certain store to make their WIC purchases. For each one, please tell me how important it is to you by giving a number from 0 to 5, with 5 meaning extremely important and 0 being not important at all. How important is it that [INSERT FROM BELOW]:
Extremely important Not at all important
5-----------4-----------3-----------2-----------1 0 [ROTATE START POINT]
It is the same store where you do your other shopping
The store clerks are friendly and helpful
The store clerks speak your language
The location is safe
The location is convenient, easy to get to
The store hours are convenient
The store has the right sizes and brands of WIC foods
The prices on non-WIC items are reasonable
It is easy to identify the WIC approved food items in the store
The store offers incentives for my WIC purchases
The store has a large selection of WIC-approved food items for me to choose
The store only carries WIC items
Q28. Thinking about the store
where you usually shop, how often does that store have all of the
WIC-approved food items you want to buy for your
child during your
visit? Would you say . . .
[CHECK
one]
Never
Almost never
Occasionally/Sometimes
Almost every time
Every time
NOT SURE
REFUSED
Q29. How do you usually get to the store when you need to go there? [DO NOT READ. check all that apply]
PERSONAL CAR
TAXI
UBER/LYFT
BUS
LIGHT RAIL/SUBWAY/COMMUTER TRAIN
WALK
BIKE
GET A RIDE FROM SOMEONE
OTHER (PLEASE SPECIFY):_________________________
NOT SURE
REFUSED
Q30A. How long does it usually take you to get to the store where you usually purchase food items using [SHOW Q29 ANSWER]? [accept one number]
____ HOURS ____ MINUTES
NOT SURE
REFUSED
Q30B.
How many times in a typical month do you usually go to the store to
purchase food? [accept
one number]
______ TIMES
NOT SURE
REFUSED
Q31. On average, how much of the WIC benefits do you use for your child each month? [CHECK one]
All of it
Most of it
Half of it
A little of it
None of it
NOT SURE
REFUSED
[ASK Q32 and Q32A-E IF STATE AUTHORIZES USE of WIC benefits AT FARMERS’ MARKET]
Q32. Is there a farmers’ market located near where you live? [CHECK one]
YES
NO [GO TO Q32b]
NOT SURE [GO TO Q32b]
REFUSED [GO TO Q32b]
Q32A. How far away, in miles, is the farmers’ market located from where you live? [CHECK one]
______ MILES
NOT SURE
REFUSED
Q32B. Are you aware that you can use your child’s WIC benefits at farmers’ markets? [CHECK one]
YES
NO [GO TO Q33]
NOT SURE [GO TO Q33]
REFUSED [GO TO Q33]
Q32C. How often do you use your child’s WIC benefits at farmers’ markets? [CHECK one]
All of the time
Often
Occasionally
Seldom
Never
NOT SURE
REFUSED
Q32D. Do you prefer to use your child’s WIC benefits to purchase fruits and vegetables at the grocery store or the farmers’ market? [CHECK one]
GROCERY STORE [go to Q32e]
FARMERS’ MARKET [go to Q32e]
NOT SURE [go to Q33]
REFUSED [go to Q33]
Q32E. Please explain why you prefer to use your WIC benefits to purchase fruits and vegetables at the [insert response from Q33d]. ________________________________________________________
Q33. Now thinking about how your family eats generally, which of the following statements best describes the food you had to eat in your household during the last 12 months? Did your household . . [READ LIST]? [CHECK ONE]
Have enough to eat [go TO Q35]
Sometimes not have enough to eat, or
Often not have enough to eat
Q33A. Now I am going to ask a series of questions about food and meals. For each question, tell me if this applies to you often, sometimes, or never in the last 12 months. [REPEAT SCALE AS NECESSARY] [CHECK one] |
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1) How often did you worry whether your food would run out before you got money to buy more. |
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2) How often did the food that you buy not last and you didn’t have money to get more. |
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3) How often could you not afford to eat balanced meals. |
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4) How often did you rely on only a few kinds of low-cost food to feed our children because you were running out of money to buy food. |
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5) How often could you not feed your children a balanced meal, because you couldn’t afford that. |
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6) How often did the children not eat enough because you just couldn’t afford enough food. |
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Q33B. In the last 12 months, did you or other adults in the household ever cut the size of your meals or skip meals because there wasn’t enough money for food? |
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1) How often did this happen—almost every month, some months but not every month, or in only 1 or 2 months? |
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Q33C. In the last 12 months, did you ever eat less than you felt you should because there wasn’t enough money for food? |
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Q33D. In the last 12 months, were you ever hungry, but didn’t eat, because there wasn’t enough money for food? |
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Q33E. In the last 12 months, did you lose weight because there wasn’t enough money for food? |
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Q33F. In the last 12 months, did you or other adults in your household ever not eat for a whole day because there wasn’t enough money for food? |
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Q33G. How often did this happen—almost every month, some months but not every month, or in only 1 or 2 months? |
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Q34A. In
the last 12 months, did you ever cut the size of any of the
children’s meals because there wasn’t enough money for
food? |
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Q34B. In the last 12 months, were the children ever hungry but you just couldn’t afford more food? |
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Q34C. In the last 12 months, did any of the children ever skip a meal because there wasn’t enough money for food? |
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Q34D. How often did this happen—almost every month, some months but not every month, or in only 1 or 2 months? |
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Q34E. In the last 12 months, did any of the children ever not eat for a whole day because there wasn’t enough money for food? |
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Q35. At the current time, what, if any, health insurance do you have for your child/ren? [IF R. SAYS SOMETHING LIKE “AETNA, BLUE CROSS/BLUE SHIELD, KAISER, OR UNITED HEALTHCARE,” CLARIFY WHETHER IT IS PRIVATE INSURANCE THROUGH AN EMPLOYER OR NOT. IF MORE THAN ONE GIVEN, ASK FOR MAIN ONE.] [CHECK one]
NONE
MEDICAID
STATE CHIP – CHILDREN’S HEALTH INSURANCE PROGRAM
OTHER STATE PROGRAM (PLEASE SPECIFY): _______________
MILITARY/TRICARE
PRIVATE INSURANCE THROUGH AN EMPLOYER
PRIVATE INSURANCE NOT THROUGH AN EMPLOYER (I.E., THEIR OWN INSURANCE)
OTHER (PLEASE SPECIFY):
NOT SURE
REFUSED
Q37. Were you given information about the Medicaid Program during your child’s WIC Program certification process? [CHECK one]
YES
NO
NOT SURE
REFUSED
Q37A. Were you referred to the Medicaid Program during your child’s visit? [CHECK one]
YES
NO
NOT SURE
REFUSED
Q38.
Have you, or members of your family, ever received food through the
. . . [READ
LIST]?
TAILOR TO STATE PROGRAM NAMES WHERE APPLICABLE |
Q38A. Ever |
Q38B. Currently |
Q38C. How long have you participated |
a. Supplemental Nutrition Assistance Program (SNAP) |
YES NO |
YES NO NA |
YEARS ____ MONTHS ____ |
b. Head Start/Early Head Start |
YES NO |
YES NO NA |
YEARS ____ MONTHS ____ |
c. Free or Reduced Price School Lunch or Breakfast Program |
YES NO |
YES NO NA |
YEARS ____ MONTHS ____ |
d. Summer Food Service Program (SFSP), for kids when not in school |
YES NO |
YES NO NA |
YEARS ____ MONTHS ____ |
e The Emergency Food Assistance program |
YES NO |
YES NO NA |
YEARS ____ MONTHS ____ |
f. Free meals for children at daycare centers (Child and Adult Care Food program) (CACFP) |
YES NO |
YES NO NA |
YEARS ____ MONTHS ____ |
h. Local/community food bank or pantry |
YES NO |
YES NO NA |
YEARS ____ MONTHS ____ |
i. Commodity Supplemental Food Program, which provides food packages that are distributed through State and local agencies |
YES NO |
YES NO NA |
YEARS ____ MONTHS ____ |
Q39. [IF CURRENT OR FORMER SNAP PARTICIPANT IN Q38A, ASK] Which program did you (or your child) enroll in first, SNAP or WIC? [don’t read] [CHECK one]
SNAP: SELF
SNAP: CHILD
WIC: SELF
WIC: CHILD
THE SAME DAY: SELF
THE SAME DAY: CHILD
NOT SURE
REFUSED
Q40. Has participating in WIC changed how you use these other programs? [CHECK one]
YES: PLEASE EXPLAIN: ___________________________________
NO
NOT SURE
REFUSED
Q40A. [ask if yes to Q40] Did you learn through WIC that you or your child/ren were eligible for one of the previously mentioned programs? [CHECK one]
YES
NO
NOT SURE
REFUSED
Q40B. [ask if yes to Q40A] Did you apply for one of these previously mentioned programs after learning through WIC that you or your child/ren were eligible for them? [CHECK one]
YES
NO
NOT SURE
REFUSED
Q40C. [ask if yes to Q40. if responded no, go to Q41] With WIC, are you able to use your child’s [STATE TANF NAME] benefits for other expenses? [CHECK one]
YES
NO
NOT SURE
REFUSED
Q41. Do you have friends who have children that you think are eligible for WIC but who haven’t applied? [CHECK one]
YES
NO
NOT SURE
REFUSED
Q41A. What, do you think, are the main reasons that people who could participate in WIC do not? PROBE: Anything else? [DO NOT READ. CODE UP TO THREE REPLIES.]
LACK OF TRANSPORTATION TO CLINIC, TRANSPORTATION DIFFICULTIES
THEY DON’T KNOW THAT WIC EXISTS
ASSUME THEY ARE NOT ELIGIBLE
ASSUME BENEFITS ARE NOT WORTH THE EFFORT TO APPLY
INCONVENIENT HOURS/DAYS CLINIC OPEN
SERVICES (INCLUDING WAITING TIME) TAKE TOO MUCH TIME
WAITING SPACE AT CLINIC IS LIMITED
LACK OF CHILD CARE
LANGUAGE BARRIERS
PROBLEMS QUALIFYING FOR BENEFITS
DIFFICULTIES KEEPING APPOINTMENT TIMES
WIC FOOD SELECTION NOT DESIRABLE
WIC FOOD STORES NOT CONVENIENT (HOURS OR LOCATION)
WIC FOOD HARD TO FIND ON SHELVES (BRANDS, QUANTITIES)
DO NOT WANT TO PARTICIPATE IN A FOOD ASSISTANCE PROGRAM BECAUSE OF THE STIGMA
CONCERNS WITH CITIZENSHIP
DIDN’T NEED FOOD BENEFIT
OTHER: PLEASE SPECIFY
We’re almost done with this survey. I’d like to ask these last few questions for classification purposes only.
Q42. Is your child . . . [READ ALL. CHECK one.]
Hispanic or Latino
Not Hispanic or Latino
Q43. How would you characterize your child’s race? [READ ALL. CHECK all that APPLY]
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Q45.
What is your child’s
primary language, that is, the language they speak at
home?
[do
not read. CHECK one.]
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| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Amy Wieczorek, MPH |
| File Modified | 0000-00-00 |
| File Created | 2021-01-21 |