Arkansas Child Find Awareness Evaluation Parent Survey
Tell us about your family.
What County do you live in?
Select Option Below
Arkansas
Ashley
Baxter
Benton
Boone
Bradley
Calhoun
Carroll
Chicot
Clark
Clay
Cleburne
Cleveland
Columbia
Conway
Craighead
Crawford
Crittenden
Cross
Dallas
Desha
Drew
Faulkner
Franklin
Fulton
Garland
Grant
Greene
Hempstead
Hot Spring
Howard
Independence
Izard
Jackson
Jefferson
Johnson
Lafayette
Lawrence
Lee
Lincoln
Little River
Logan
Lonoke
Madison
Marion
Miller
Mississippi
Monroe
Montgomery
Nevada
Newton
Ouachita
Perry
Phillips
Pike
Poinsett
Polk
Pope
Prairie
Pulaski
Randolph
Saline
Scott
Searcy
Sebastian
Sevier
Sharp
St. Francis
Stone
Union
Van Buren
Washington
White
Woodruff
Yell
What School district do you live in?
How many children are in your family?
Select option below
1
2
3
4
5
6
7
8
9
10
List age of each child below.
How did you learn about the program?
Special Ed. Services
Early Intervention (0-3)
Select option below
Television
Radio
Told By Someone
Printed Material
Early Childhood (3-5)
Select option below
Television
Radio
Told By Someone
Printed Material
School Age (6-21)
Select option below
Television
Radio
Told By Someone
Printed Material
If you received printed materials, please tell us about them.
Did you find the materials you received easy to read and understand?
Yes
No
Did the materials you received have enough information to tell you about the program and how to get help?
Yes
No
If not, please tell us how to improve it.
Who gave you the printed material?
Select option below
Another Parent
Child Care Provider
CHMS Center
Community Agency
DDS Center
Department of Human Services
Family Member or Friend
Parent Information and Training Center
Physician
School Based Parent Center
School
Therapist
Website
Other
Other: