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Be the Difference
Give Us Your Opinion
Parent Survey
This survey is designed for parents to complete. It will provide us with a general framework for understanding your attitudes toward parenting and your involvement with family. You will note that your privacy is protected -- we do not ask for personal information. We appreciate you for taking the time to complete this survey!
(Input Word from the image)
Are you
Married
Living with a partner
Single father with children
Single mother with children
Living apart from your children
How old are you?
PLEASE SELECT
15-18
19-22
23-26
27-30
31-35
36-40
41-45
Over 45
How old is your partner?
PLEASE SELECT
15-18
19-22
23-26
27-30
31-35
36-40
41-45
Over 45
How many children do you have?
PLEASE SELECT
0
1
2
3
4
5 or more
As a parent, how engaged are you with your children?
A great deal
A fair amount
Not very much
How engaged is your partner with your children?
A great deal
A fair amount
Not very much
How engaged are you with your partner?
A great deal
A fair amount
Not very much
How much were you influenced by your mother?
Very
Fair
Not very
How much were you influenced by your father?
Very
Fair
Not very
How would you rate yourself as a partner?
Very good
Good
Fair
Not so good
Poor
How would you rate yourself as a parent?
Very good
Good
Fair
Not so good
Poor
How would your children rate your performance as a parent?
Very good
Good
Fair
Not so good
Poor
Which is more important?
Spending time with your family
Being successful in your career
If you had more time, could you be a better parent?
Yes
No
Do you feel that you have sufficient support mechanisms in place to be a good parent? (i.e. from family, friends, work, school, church, et cetera)
Yes
No
Are there organizations within your community that you look to for parent education/programming?
Yes
No
If you answered 'yes' to the previous question, what type of organization provides these services?
Faith-based organizations
Community-based organizations
Government entities
Educational institutions
What area of need is most critical to your role as a parent?
Spouse/partner relationship
Job-related needs
Job training/education
Parenting skills
Other
Would you attend a parenting—
Parenting education/training class
Conference/seminar
Support group
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