Single Parent Project Survey
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1
. What is your gender?
What is your gender?
Male
Female
2
. How many children do you have?
How many children do you have?
None
1
2-4
4 or more
3
. What is your marital status?
What is your marital status?
Single-Never Married
Married
Divorced
Widow
Other (please specify)
4
. Are you currently employed?
Are you currently employed?
Yes
No
Other (please specify)
5
. What is your income level/range
What is your income level/range
$0-$10,000
$10,001-$29,000
$30,000- $45, 000
$45,001 or more
6
. Are you currently or have you received federal government assistance programs such as TANF, Food Stamps, Daycare assistance, or health insurance, if so please click all that apply
Are you currently or have you received federal government assistance programs such as TANF, Food Stamps, Daycare assistance, or health insurance, if so please click all that apply
TANF-Welfare
Food Stamps
Daycare Assistance
Health Insurance(such as Neighborhood Health Plan or Medicare)
7
. Have you used any paid child care services for your child or children such as childcare centers or home daycare?
Have you used any paid child care services for your child or children such as childcare centers or home daycare?
Yes
No
Other (please specify)
8
. If you identify as a single parent, what do you find to be the most challenging about being a single parent? Please click all that apply.
If you identify as a single parent, what do you find to be the most challenging about being a single parent? Please click all that apply.
Childcare
Providing Clothing, Food, and Shelter for Children
Work/Life Balance
Quality Time With Children
Continuing Education
Accessing Quality Education for Your Children
Dealing with Assumptions Associated With Being A Single Parent
Absentee Parent
Other (please specify)
*
9
. What are some of assumptions or stereotypes associated with being a single parent?
What are some of assumptions or stereotypes associated with being a single parent?
*
10
. As a single parent, what type of services would like to see become available to you and your family?
As a single parent, what type of services would like to see become available to you and your family?
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