Child Care Setting Recruitment Form

TOPIC CATEGORY	QUESTION	RESPONSE CATEGORIES
	This information will be collected during the first call to determine elgiblility
Name of Setting
Name of Gatekeeper
Name of SPP
Contact info for SPP, phone, email, address
Year that the business or program was established.
Number of Classrooms with 2 or more children 30 months or younger.	WE WILL FILL THE DATE THEY WOULD HAVE TO BE BORN AFTER TO BE ELIGIBLE
	This information will be collected during the second call with the SPP
FOR EACH ELIGIBLE CLASSROOM THE FOLLOWING INFORMATION WILL BE COLLECTED	When we last spoke, you mentioned that there are/is [NUMBER] classroom(s) at your child care setting that have 2 or more children that are younger than 30 months. In other words, born after [DATE]. I am calling to get more information on each of these classrooms so that we can get ready to observe the classrooms and because we will make questionnaires for the teacher(s) and parents of the children. Let's start with the first classroom.
Classroom name	What is this classroom called?	OPEN-ENDED
Number of teachers in classroom	How many teachers work in this classroom more than 4 hours a day?	2 DIGIT NUMBER - FOLLOW WITH COLLECTING THEIR NAME(S), TITLE, and TYPICAL SHIFT (START TIME, END TIME)
Number of teachers in classroom	And how many teachers, classroom aides, or volunteers work in this classroom less than 4 hours a day?	2 DIGIT NUMBER
Languages Spoken in Classroom	What languages do the caregivers speak in this classroom?	MARK ALL THAT APPLY 1. English 2. Spanish 3. Other (Specify)
Sharing load?	Which best describes how the workload is shared among caregivers in each classroom?	One caregiver is assigned to a small group of children, Caregivers share responsibility equally for all children, The lead caregiver and assistant caregivers share responsibility for all children, or Some other rrangement?(SPECIFY) ADD NOTES
Number of Children in Classroom/Group	How many children are currently enrolled in this classroom (regardless of age)?	2 DIGIT NUMBER
	The next questions are about the children in the classroom who are 30 months and younger. That means children born after [DATE]. Because we will be preparing questionnaires for each child's parents and the questionnaires are different based on the child's age, for each child, I need to record his or her name, date of birth, household language, and phone numbers in case we need to follow-up with a phone call to his or her parents.
for each elible child	CHILD NAME/ DOB/ HOUSEHOLD LANGUAGE/ CELL PHONE/ HOME PHONE/ OTHER PHONE/ NOTES