DA Form 5562-r Child Development Services Needs Assessment

DA Form 5562-r or the "Child Development Services Needs Assessment" is a Department of the Army-issued form used by and within the United States Military.

The form - often incorrectly referred to as the DD form 5562-r - was last revised on July 1, 1989. Download an up-to-date fillable DA Form 5562-r down below in PDF-format or look it up on the Army Publishing Directorate website.

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CHILD DEVELOPMENT SERVICES NEEDS ASSESSMENT
For use of this form, see AR 608-10; the proponent agency is DCSPER
The results of this form will be used to help formulate plans for changes in Child Development Services (CDS) program and facilities within the
community.
1. TO (Name and Location)
2. FROM
3. RETURN THIS FORM BY
(Enter Date)
TELEPHONE
SPONSOR: GRADE/RANK
SPOUSE: GRADE/RANK
MILITARY
DOD
MILITARY
DOD
CIV
CIV
4. HOW MANY CHILDREN DO YOU HAVE IN THE FOLLOWING AGE GROUPS
a. Birth to 18 Months
c.
3 Years to 5 Years
b. 18 Months to 3 Years
d.
6 Years to 12 Years
5. HOW MANY OF YOUR CHILDREN RECEIVE THE FOLLOWING TYPE OF CHILD CARE
e. Attends off-post child care center, preschool
a. Attends the installation Child Development center
nursery, etc.
b. Receives care from an on-post family child care
f. Receives care from off-post family child provider
provider
or babysitter
g. Requires no child care
c. Receives care from an on-post babysitter
(uncertified)
h. Requires care not currently available (Specify)
d. Receives care from babysitter or relative in own
home
6. RANK YOUR PREFERENCE FOR TYPE OF CHILD CARE (1 to 5 with 1 being most preferred)
1
2
3
4
5
a. Army Child Development Center
b. Army Family Child Care Home
c. Off-Post Child Development Center
d. Off-Post Family Child Care Home
e. In-Home Care (Relative or Babysitter)
f. School-Age/Latch Key
7. WOULD YOUR CHILD(REN) ATTEND A NEW INSTALLATION CHILD DEVELOPMENT CENTER IF CONSTRUCTION INCREASED
CAPACITY?
YES
NO
8. IF YES TO ITEM 7. WHICH PROGRAM(S) WOULD YOUR CHILD(REN) ATTEND? (Check all that apply)
a. Infant Full Day
f. Preschool Full Day
b. Infant Hourly
g. Preschool Part Day
c. Toddler Full Day
h. Preschool Hourly
d. Toddler Hourly
i. School Age Summer
e. Family Child Care Home
j. School Age (Before/After School)
DA FORM 5562-R, JUL 1989
EDITION OF SEP 86 IS OBSOLETE
APD LC v2.00
CHILD DEVELOPMENT SERVICES NEEDS ASSESSMENT
For use of this form, see AR 608-10; the proponent agency is DCSPER
The results of this form will be used to help formulate plans for changes in Child Development Services (CDS) program and facilities within the
community.
1. TO (Name and Location)
2. FROM
3. RETURN THIS FORM BY
(Enter Date)
TELEPHONE
SPONSOR: GRADE/RANK
SPOUSE: GRADE/RANK
MILITARY
DOD
MILITARY
DOD
CIV
CIV
4. HOW MANY CHILDREN DO YOU HAVE IN THE FOLLOWING AGE GROUPS
a. Birth to 18 Months
c.
3 Years to 5 Years
b. 18 Months to 3 Years
d.
6 Years to 12 Years
5. HOW MANY OF YOUR CHILDREN RECEIVE THE FOLLOWING TYPE OF CHILD CARE
e. Attends off-post child care center, preschool
a. Attends the installation Child Development center
nursery, etc.
b. Receives care from an on-post family child care
f. Receives care from off-post family child provider
provider
or babysitter
g. Requires no child care
c. Receives care from an on-post babysitter
(uncertified)
h. Requires care not currently available (Specify)
d. Receives care from babysitter or relative in own
home
6. RANK YOUR PREFERENCE FOR TYPE OF CHILD CARE (1 to 5 with 1 being most preferred)
1
2
3
4
5
a. Army Child Development Center
b. Army Family Child Care Home
c. Off-Post Child Development Center
d. Off-Post Family Child Care Home
e. In-Home Care (Relative or Babysitter)
f. School-Age/Latch Key
7. WOULD YOUR CHILD(REN) ATTEND A NEW INSTALLATION CHILD DEVELOPMENT CENTER IF CONSTRUCTION INCREASED
CAPACITY?
YES
NO
8. IF YES TO ITEM 7. WHICH PROGRAM(S) WOULD YOUR CHILD(REN) ATTEND? (Check all that apply)
a. Infant Full Day
f. Preschool Full Day
b. Infant Hourly
g. Preschool Part Day
c. Toddler Full Day
h. Preschool Hourly
d. Toddler Hourly
i. School Age Summer
e. Family Child Care Home
j. School Age (Before/After School)
DA FORM 5562-R, JUL 1989
EDITION OF SEP 86 IS OBSOLETE
APD LC v2.00
9. IS YOUR CHILD NOW ON THE WAITING LIST
If No, what is preventing you from using the waiting list?
TO ATTEND THE CHILD DEVELOPMENT CENTER?
YES
NO
TO ATTEND A FAMILY CHILD CARE HOME?
YES
NO
10. HOW WOULD YOU RATE YOUR LEVEL OF SATISFACTION WITH EACH OF THE FOLLOWING REGARDING YOUR
INSTALLATION CHILD DEVELOPMENT CENTER/FAMILY CHILD CARE HOME?
VERY
VERY
GOOD
FAIR
POOR
GOOD
POOR
a.
General Operation
b.
Operating Hours
c.
Quality of Program
d.
Quality of Staff
e.
Quality/Adequacy of Facility
f.
Availability of Hourly Care
g.
Availability of Full Day Care
h.
Availability of Part Day Care
i.
Fees Charged
j.
Other (Specify)
11. WHAT ARE YOUR REASONS FOR NOT USING ARMY CHILD DEVELOPMENT SERVICES MORE OFTEN? (Check)
a. Does not apply. I use child care as
f. Quality of staff is poor
often as I need.
b. Conditions of facility are poor.
g. Quality of program is poor
c. Cost is too much.
h. Facility is too crowded.
Child care facility is too far from where I
d.
i. Child care is not available for my needs
live.
(Explain).
j. Other (Explain).
e. Inadequate facility.
12. ADDITIONAL COMMENTS/EXPLANATIONS
APD LC v2.00
REVERSE, DA FORM 5562-R, JUL 1989

Download DA Form 5562-r Child Development Services Needs Assessment

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