Demographic Survey

Please respond to each of the following items and click on the "Save Demographic Survey" button once you have completed the survey.

Highest Education Level:

	GED
	HS Diploma
	Bachelors
	Masters
	Doctoral
	Other

Certification Level:

	CDA
	CDA-Equivalent
	Florida Certified Teacher
	Other

Are you currently employed as a VPK Instructor?

	Yes
	No

Are you currently employed as an Instructor at a site that offers the School Readiness Program?

	Yes
	No
	Not Sure

Center/School Name

Center/School Address Line 1

Center/School Address Line 2

Center/School Phone Number

County of Center

Alachua Baker Bay Bradford Brevard Broward Calhoun Charlotte Citrus Clay Collier Columbia Miami-Dade DeSoto Dixie Duval Escambia Flagler Franklin Gadsden Gilchrist Glades Gulf Hamilton Hardee Hendry Hernando Highlands Hillsborough Holmes Indian River Jackson Jefferson Lafayette Lake Lee Leon Levy Liberty Madison Manatee Marion Martin Monroe Nassau Okaloosa Okeechobee Orange Osceola Palm Beach Pasco Pinellas Polk Putnam St. Johns St. Lucie Santa Rosa Sarasota Seminole Sumter Suwannee Taylor Union Volusia Wakulla Walton Washington

Center Type

Private Provider Public School Provider

Center Director's Name (optional)