In order to monitor and improve our services that we provide to you, we would be grateful if you would spare some time to fill in this Customer Evaluation Form, regarding the services you received and information given. *Please note all information given is confidential and is for the sole purpose of monitoring our service, you do not have to answer any questions you feel you dont want to, just simply leave blank.*

1.	How did you find out about The Family Hub website?
	Internet		Leaflet / Poster		Local Authority Department		Registy Office
	Friend / Family		Childcare Provider		Yellow Pages		Job Centre
	Professional		Health Visitor / Midwives		Thompson Local

2.	Is this your first visit to The Family Hub Website?
	Yes
	No

3.	What type of childcare were you looking for?
	Childminder		Children's Centre		Playgroup		Playscheme
	Private Nursery		School Nursery		Out of School Club

4.

What postcode did you use to search?

5.	How old are your children?
	Pregnant		Age 1		Age 3		Age 5+
	Under 1		Age 2		Age 4		Age 10+

6.	Do you already use Childcare?
	Yes
	No

7.	What type of Childcare do you currently use?
	Childminder		Children's Centre		Playgroup		Playscheme
	Private Nursery		School Nursery		Out of School Club		Friend / Relative

8.	Did you use The Family Hub to find your current Childcare?
	Yes
	No

	Please state how you found your current Childcare?

9.	What are your reasons for searching for Childcare?
	Returning to work after Maternity		Change in Circumstances		Respite / Emergency		Other
	Seeking work		Job Training		Socialisation
	College / Study		Relocation		Current Childcare not suitable

	Please state your enquiry reason?

	Please state why your current Childcare is no longer suitable?

10.	Were you successful in finding the Childcare you required?
	Yes
	No

	Please state why you wasn't successful in Finding Childcare?

11.	Are you claiming Working Families Child Tax Credits
	Yes
	No

12.	Why?
	Not aware of tax credits
	Work less than 16 hours
	Earnings are higher than the threshold

13.

Please enter your name and address in the box to the right if you would like us to send you some information on Working Families Child Tax Credits.

14.	Did you find the Website useful?
	Yes
	No

	Please state reasons why?

15.	Would you use the website in the future?
	Yes
	No

16.	Please indicate how you would rate our website overall?
	Very Good	Good	Poor	Very Poor

17.	Please use the space below to give us any kind of Feedback?

18.	If you would like us to contact you relating to any issues you may have with using our website please supply us with your contact details
	Name
	Telephone
	E-mail

Equality Monitoring *Please note all information given is confidential and is for the sole purpose of monitoring our service, you do not have to answer any questions you feel you dont want to, just simply leave blank.*

19.	Gender?
	Male		Female

20.	What is your Age Range?
	Upto 19		20-30		31-40		41-50		Over 51

21.	What is your employment/ benefit status?
	Working (16hours plus)		Claiming Income Support		In Training/Education		Claiming Job Seekers Allowance
	Not Working/Training		Claiming Incapacity Benefit		Claiming Workless Benefits

22.	What are your working hours
	Less than 16 hours		16-30 hours		More than 30 hours

23.	Are you a Lone Parent?
	Yes
	No

24.	Do you have a Disability
	Yes
	No

25.	Sexual Orientation
	Heterosexual / Straight		Gay		Bisexual		Transexual

26.	Are you an Asylum Seeker/Refugee?
	Yes
	No

27.	Religion
	Christian		Sikh		Atheist
	Muslim		Hindu		Other

	Please state Religion

28.	Ethnicity
	Asian or Asian British  - Indian		Black or Black British - other Black backgrouond		Mixed: White/Asian
	Asian or Asian British - Pakistani		Chinese		Mixed: White/Black African
	Asian or Asian British - Bangladeshi		Gypsy/Roma		Mixed: White/Black Caribbean
	Asian or Asian British - other Asian background		Traveller of Irish Heritage		Other mixed background
	Black or Black British - Caribbean		White British		Other white background
	Black or Black British - African		White Irish		Other

	Please state other Ethnic background not listed?

Thank you for your time