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Imported Block 1 - Sep 25, 2020
The U.S. State Department’s Bureau of Educational and Cultural Affairs (ECA) would like to ask you a
few questions about your experiences in the Au Pair program. The goal is to better understand both
successes and challenges of this program.
Please complete this survey by November 30. The survey has 20-25 questions and should take less
than 30 minutes to complete.
Your responses will be anonymous and aggregated with other responses for the reporting purposes.
The results of this survey are for internal ECA use only, and will not be shared publicly.
The only instances when your name may be used are for the purpose of follow-up on specific problems
identified in this survey. The Department of State works with Au Pair exchange visitors when they have
serious concerns about their placement and their sponsor is unwilling or unable to assist them. In these
cases, a member of our team may contact you for additional details and possible follow-up.
Your participation in this survey is voluntary, and you are free to choose not to answer any question. Your
completion of the survey will not affect your eligibility for future Au Pair or other ECA programs.
Contact the ECA Evaluation team ([email protected]) for technical support with the survey
system or inquiries about specific questions.
By clicking “Yes” you confirm that you have read the above consent information and agree to voluntarily
participate in this survey.
Yes - take me to the survey
No - exit the survey
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Please enter the following information
First Name
Middle Name
Last Name
Date of Birth (mm-dd-yyyy)
Email address
Please select your country of citizenship.
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Please enter SEVIS ID number.
(Found in top right-hand corner of your of DS-2019 form)
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Please enter current U.S. placement city
Please select current U.S. placement state
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Do you currently have access to a computer or cell phone?
Yes
No
Please specify your device. Check all that apply.
Cell phone
Smart phone
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Tablet
Computer with microphone
Computer with microphone and camera
Other (please describe)
How long have you participated in the Au Pair program? Please indicate number of
months.
0
3
6
9
12
15
18
21
24
Number of months
as Au Pair
Given COVID-19 restrictions, what kinds of cultural activities have you participated
in?
Virtual cluster meetings
Virtual meetings with other Americans
Virtual meetings with other Au Pairs
Socially distanced outdoor activities
Celebrating holidays
Other (please describe)
None
Please indicate your level of satisfaction with your current host family.
Extremely satisfied
Somewhat satisfied
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Neither satisfied nor dissatisfied
Somewhat dissatisfied
Extremely dissatisfied
Please explain the reason(s) why you are dissatisfied. Check all that apply.
Perform duties outside of childcare
Work more than 10 hours a day and 45 hours a week
Do not have private bedroom
Do not get along with host children
Do not get along with host parents
Do not receive a minimum of one and one half days off per week in addition to one
complete weekend off each month
Did not receive two week vacation
Did not receive stipend
Other (please describe)
How many hours a week do you work?
0
5
10
15
20
25
30
35
40
45
50
55
60
Hour per week
Have you been asked to do work not related to childcare?
Yes
No
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Please provide examples of your non-childcare work. Check all that apply.
Cleaning common living areas
Taking care of family pet
Doing host parent’s laundry
Washing the car
Grocery shopping for host parent
Other (please describe)
Do you feel safe and comfortable in your host family house?
Yes
No
Please explain why you do not feel safe and/or comfortable. Check all that apply.
Conflict with host father
Conflict with host mother
Conflict with other members of host household
No privacy in bedroom
No privacy in bathroom
Far away from public transportation
Far away from local attractions
Doors do not lock
Other (please describe)
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Please provide more detail on the nature of this conflict.
Please indicate your level of satisfaction with your sponsor.
Extremely satisfied
Somewhat satisfied
Neither satisfied nor dissatisfied
Somewhat dissatisfied
Extremely dissatisfied
Please explain the reason(s) why you are dissatisfied. Check all that apply.
Does not help with host family problems
Does not help with medical questions
Does not respond to questions
Does not regularly contact me
My local coordinator is not helpful
Other (please describe)
How often do you communicate with your local coordinator?
Every day or nearly every day
Once per week
Once per month
Once every few months
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Once or twice a year
Never
How much did participation in the program change your understanding or
knowledge of the following topics?
No change
Minimal change
Moderate change
Substantial
change
United States values
and culture
Daily life in the United
States
Religious and ethnic
diversity in the United
States
Freedom of speech and
press in the United
States
Overall, how would you describe your Au Pair program experience?
Extremely positive
Somewhat positive
Neither positive nor negative
Somewhat negative
Extremely negative
Please indicate the primary reason for your negative experience.
Sponsor
Host Family
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Educational Component
Other (please describe)
Do you have any additional comments or concerns you would like to share with
us? Please describe.
Please take note of the below Department of State emergency contact informa on:
Exchange Visitor Program
Emergency Hotline: 24/7 toll-free: 1-866-283-9090
Email/General Inquires: [email protected]
Regulations: J-1 Visa Program
Website: http://j1visa.state.gov
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| File Type | application/pdf |
| File Modified | 2020-12-11 |
| File Created | 2020-12-11 |