How many preschool children (birth to fifth birthday) in the house? 

Child's First Name

Child's Last Name

​

Date of Birth

Gender

Ethnicity

Single- parent household?

Parent’s Name    

Mailing Address

Gender of Parents

Parent’s Ethnicity

Parent’s Income

Parent’s Highest Level of Education

Second- parent in household?

Second Parent’s Ethnicity

Second Parent’s Income

Second Parent’s Highest Level of Education

How did you hear about the Reading Huddle program? 

How many children’s books are in the household?

How many caregivers read to your child/children on a daily basis?

Who are the caregivers who read to your child/children on a daily basis?

How can we have each caregiver identified as Struggling Reader?