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Daycare Interest Survey
Please complete the following survey to indicate your interest in Little Scholars.
Address Line 1
Address Line 2
Are you a MOMentum Network member?
Please select one of the following choices. We prioritize MOMentum Network members & prospective members in order to further our mission.
Mom On Campus member
Single Mom in College (not a member yet)
Village Volunteer (registered)
None of the Above
School &/or Employer
Child(ren) Name(s) & Birthdates
Please enter the name(s) of the child(ren) needing care, and their birthdates.
Is your child currently enrolled in care?
Please select "yes" or "no" reflecting if your child is currently enrolled for care at another facility. If the answer is yes, please indicate your reason for leaving.
Do you currrently receive state assistance for childcare payments?
If you receive assistance from a program like Smart Steps or Families First, please select "yes." We may prioritize a percentage of assistance recipients in order to further our mission.
Prefer not to say
Why are you interested in enrolling your child(ren) at Little Scholars?
Please indicate why you are searching for a new facility.
Put 0 if you are not currently employed
Put 0 if you are not currently enrolled in college
How soon do you need care?