CCPU Provider Communication and Demographic Survey
Thank you for participating in our survey. Your responses will help us better understand and support your needs as a provider. This survey should take approximately 10 minutes to complete. All information collected will be kept confidential.
Contact Details
First Name
Last Name
Cell Phone Number
Email Address
Postal/Zip Code
What is your preferred language for receiving communications?
English
Spanish
Portuguese
Russian
Simplified Chinese
Somali
Arabic
Farsi
Vietnamese
Other
Please specify other language
Please select your age range:
Under 18
18-24
25-34
35-44
45-54
55-64
65 and above
What is your gender?
Male
Female
Non-binary
Prefer not to say
Other
Please specify other gender
Please rate your preferred methods of communication using the scale below:
Never
Rarely
Sometimes
Often
Always
Email
Phone Call
Text Message
Social Media
Whatsapp
Mail
Other
Please specify other method of communication
What type of provider are you?
Licensed
License-exempt
How long have you been a provider?
Less than 1 year
1-3 years
4-6 years
7-10 years
More than 10 years
Have you received a state subsidy at least once in the last 12 months?
Yes
No
Would you like to receive more information about our programs and services?
Yes
No
Which social media channels do you visit within a typical day/week?
Never
Less than once a week
1-2 times a week
3-4 times a week
Daily
Multiple times per day
Facebook
Twitter
Instagram
LinkedIn
YouTube
TikTok
Other
Please specify other method of communication
Contact Information