Grandparent Caregiver Evaluation Form
Evaluate the suitability and caregiving context of a grandparent caregiver using this structured assessment form.
Relationship to the child
*
Please Select
Maternal Grandmother
Maternal Grandfather
Paternal Grandmother
Paternal Grandfather
Other
Current living situation
*
Lives with the child
Lives separately but nearby
Lives far from the child
Other
How many years of caregiving experience do you have?
*
Please Select
None
Less than 1 year
1-3 years
4-7 years
More than 7 years
Caregiving readiness
*
1
2
3
4
5
Availability for caregiving (hours per week)
*
Please Select
Less than 10 hours
10-20 hours
21-30 hours
More than 30 hours
Types of child care responsibilities you are able to provide
*
Meal preparation
Transportation
Homework assistance
Supervision
Emotional support
Other
Support systems available to you
*
Family members
Friends
Community organizations
Healthcare professionals
Other
Level of support needed to provide care
*
No support needed
1
2
3
4
Extensive support needed
5
1 is No support needed, 5 is Extensive support needed
How confident are you in managing child care responsibilities?
*
1
2
3
4
5
Overall assessment of grandparent caregiver suitability
*
Highly suitable
Suitable
Somewhat suitable
Not suitable
Submit Evaluation
Should be Empty: