Sample Questionnaire

This survey from Debby Ann Jeffery's book Literate Beginnings: Programs for Babies and Toddlers can be adapted to fit your needs.

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Sample Baby-Toddler Program Questionnaire

Date____________________

Thank you for taking the time to fill out this questionnaire. Your answers will help plan future programs for you and your child.

Name____________________________________________________(Optional)

Address__________________________________________________(Optional)

1. How many children attend the program with you? ___________________
2. Child/children’s ages? _________________________________________
3. What is your relationship to the child? ___________Parent/legal guardian

___________Other family member ___________Babysitter/nanny

___________Other (please specify)______________________________

4. Where did you find out about the Baby-Toddler Program?

___________Library Flyer/poster ___________Friend/neighbor

___________Other (please specify)______________________________

5. Is the program day and time convenient for you? _____Yes _____No

If no, when would be a better day and time? _________ Saturday

___________Weekday (please specify) ___________________________

___________Morning __________Afternoon ___________Evening

6. Did you feel the material was appropriate for the children?

Books _____Very _____Somewhat _____Not appropriate

Finger Games _____ _____ _____

Songs _____ _____ _____

Puppets/Feltboard ______ _____ _____

Film/Video ______ _____ _____

7. Do you find the program handout sheets helpful during the program?

______Yes ______No ______Sometimes

8. Do you find it helpful to take he program handout sheets home?

______Yes ______No ______Sometimes

9. How often do you repeat elements from the program at home?

______Often ______ Sometimes ______ Never

10. Has your child’s interest in books, songs, and finger games changed

since attending the program?_____No Change ______More interested

______Less interested

11. Since attending the program, do you spend more time with your child?

Reading books? ______Yes ______No

Singing? ______Yes ______No

Doing finger games? ______Yes ______No

12. Did you have a library card before you attended the program?

______Yes ______No

13. Did your child have a library card before you began attending the

Program? ______Yes ______No

14. Do you check library materials out when you attend the program?

______Yes ______No

15. Would you recommend this program to other people with young children?

______Yes ______No

16. What do you like best about the program?
17. What do you like least about the program?
18. Do you have any suggestions or comments?