PARTICIPANT INTAKE SURVEY: (Birth to Two-Year-Olds)

PARTICIPANT FOLLOW-UP SURVEY: Talkers (Ages 2 & 3 )

Library ___________________________________________________________
Parent’s Name _________________________________________________
Phone ____________________________________________________________
Child’s name ______________________________________________________

Since attending the Raising A Reader Program, how often do you … (Please explain and then check
one box for your answer.)

1. Share books with your child? Please explain.	every day	1 – 3 times a week	rarely or never
2. Have your child name objects in pictures in books? Can you give an example?	every day	1 – 3 times a week	rarely or never
3. Use general questions to get your child to say more than one word at a time? Can you give an example?	every day	1 – 3 times a week	rarely or never
4. Visit the library with your child?	every day	1 – 3 times a week	rarely or never

5. What did you and your baby learn from this program?

6. What have you done differently with your child since you attended the program?

7. What would you like to see offered at your library in the future?

8. Do you have any other comments or suggestions for us?