Resource & Referral Feedback Survey

I requested/received referrals for the following services (select all that apply) form NewMexicoKids Resource & Referral:(Required)

Child care or NM PreK

Child Care Assistance

Basic Needs (food/clothing/shelter)

Other Community Services

Other (please specify)

How did you hear about Resource & Referral services? (Select all that apply)(Required)

Information brochure or flyer

Child Care Program

State Agency (ECECD, CYFD, DOH, etc.)

Website/Internet

Family/Friend/Colleague

Community Event/Outreach

Other (please specify)

How would you rate the quality of service you received from Resource & Referral service?(Required)

Excellent

Good

Fair

Poor

Other (please specify)

Feel free to share any additional comments or suggestions about the services you received:

Would you like to receive a free family packet containing a children's book for each of your kids and important information for your family?(Required)

Yes

Great! We will put your family packet together and mail it as soon as possible. Please give us a more information so we can get you the right packet. We will only use this information to send you this you this packet.(Required)

First Name Last Name

Address(Required)

Street Address Address Line 2 City State ZIP Code

Infant (0-1 year)(Required)