Do you know where the public library is located?
Yes
No
Do you or does anyone else in your household have a library card?
Yes
No
Have you visited the library?
Yes
No (If no, skip to question #7)
How many times in a month do you visit a public library? _______________________________
Do you have (Child's Name) along when you visit the library?
Yes
No
7. Your Child's Activities
Interviewer Instructions: (If the response to the first question is "zero" skip
to question #8)
Please tell me how many hours (Child's Name) watches television each day. _____ hours
What television programs does (Child's Name) usually watch? ____________________________
What are the languages used in the television programs that (Child's Name) watches? ___________
English
Spanish
Both English and Spanish
Other Language ______________
8. In the past week, how many times did you or someone in your family read to (Child's Name)?
Not at all
Once or twice
Three or more times
Every day
What language is used when reading to (Child's Name)?
English
Spanish
Both English and Spanish
Another Language (Specify):_________________
Unable to read to my child
9. Last week, did anyone in your family do any of the following things with (Child's Name)?
Tell him/her a story
Teach him/her letters, words, numbers
Teach him/her songs or music
Talk with him/her about family history, family culture or ethnic heritage
10. In the past year, did anyone in your family do any of the following things with (Child's Name)?
Visit a zoo or aquarium
Visit a local park, playground, gym, or swimming pool
Go to an event sponsored by a community group, ethnic group or religious organization
Go to a live show, concert, or play
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