*Note: Please understand that this survey is based on children who are infants of ages two and younger. Each question refers to children only in this age group.

1. How many of your children are two years old and younger? ___________ child(ren)
2. Who mostly takes care of your child?
a. Mother/Father
b. another relative
c. a babysitter
e. Day Care
3. How many television sets do you have in your home? Please check one answer.
a. None
b. One
c. Two
d. Three
e. More than three
4. Approximately how many hours a day is the television turned on? Please check one answer.
a. None
b.1 to 2 hours only
c. 3 to 5 hours
d.6 to10 hours
e. More than 10 hours
5. Approximately how many hours does your child watch television? Please check one answer.
a. None
b.1 to 2 hours only
c. 3 to 5 hours
d.6 to10 hours
e. More than 10 hours
6. What television programs does your child like to watch? Please check all that apply
a. PBS Channel 13
b. Nickelodeon
c. DVDs and Video cassettes
d. All children¡¯s programs in general
e. Anything that is played on TV while it is turned on.
f. None at all
7. As a parent, do you feel that TV can benefit your child¡¯s learning as long as the programs are educational? Yes / No

8. Have you ever been informed of the harmful effects of television on infants ages two and
younger? Yes / No

9. If you have answered ¡®Yes¡¯ to the previous question, have you been able to limit and control your child¡¯s television viewing? Yes / No

10. a.) As a parent, would you like to know more about the effects of television on your child? Yes / No
b.) If so, who or what should provide this information? _________________________

*** Thank you for your time and frankness in your replies. ***