Reading Habits Survey Full name of child * Age of the child: * 0 - 1 1 - 2 2 - 3 3 - 4 4 - 5 Gender of the child: * Female Male Ethnicity: * African American Hispanic Asian Native American Caucasian Other County: * Charleston Dorchester Berkeley Colleton Other Zip code of your home: * Household income level: * 0 - $25,000 $25,000 - $50,000 $50,000 - $75,000 $75,000 - $100,000 $100,000 + How many adults are in the home? * Single Parent Married/Partners Over 2 adults How many children are in the household? * 1 2 3 4+ How frequently do you read with your child? * Every day 4 - 6 days a week 1 -3 days a week Rarely Never How long is each reading session on average? * 5 - 10 minutes 10 - 20 minutes 20 - 30 minutes Over 30 minutes Do you use the Parental newsletter to assist you in reading? * Always Sometimes Never If available, does yor child use the activity sheet? * Yes No Sometimes Does your child seem to enjoy reading? * Yes No Sometimes Does your child look at or read books on their own? * Yes No Sometimes Do you enjoy reading with your child? * Yes No Sometimes Do the books arrive on a regular basis; about the same date each month? * Yes No Do you find the books to be appropriate to the age of your child? * Yes No Sometimes What challenges do you face when reading with your child? * Lack of interest (Child) Lack of interest (Parent) Limited time Competition with other things Other (If other, please specify below) What else can we do to support you with intentionally reading with your child? * If nothing, please input "N/A" Thank you!
