Early Literacy Parent Survey Form
*Allegan County Parents/Caregivers of Children Ages 0-5 Years Old
How many children (ages 0-5 years old) currently live in your home?
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2
3
4
5
1 star = 1 child
How many DAYS a week do you READ with your child?
1
2
3
4
5
6
7
1 heart = 1 day
How many MINUTES a day do you READ with your child?
1
2
3
4
5
6
7
8
9
10
1 light bulb = 1 minute
How do you help your child READ at home? Click all of the options you use.
Rows
Options You Use
Point or talk about the pictures in the story
Ask your child to repeat sounds/words in the story
Point and count objects (i.e. cats, dogs, stars, etc.) in the pictures
Point and name letters (A, B, C, ..) in the story
Point and name numbers (1, 2, 3) in the story
Point and name shapes (circle, square, triangle, rectangle, diamond, oval) in the story
Read books to your child, while they are playing in the bath tub or at mealtimes
Read books to your child in the car, at the doctor's office, restaurant, park, etc.
Where do you get FREE BOOKS to read to your child? Click all of the options you use.
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Options You Use
Local Library
Talking is Teaching Play-and-Learns
Dolly Parton Imagination Library
YouTube- Read Alouds
Little Free Libraries
Reach Out and Read (Doctor's Office)
Other
What is your favorite story to read with your child?
Name (optional)
First Name
Last Name
Email (optional)
example@example.com
Submit
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