Family Advocacy Needs Assessment

2.PAGE ONE:

Some background information will help us to understand your needs. Please circle your response or fill in the blank as needed.

1.Please indicate your age.

18 - 25

25 - 30

30 - 35

35 - 40

40 - 45

45 & Over

2.What is your sex?

Male

Female

3.Please indicate your status (Check as many as necessary).

Enlisted

Officer

Spouse of Officer

Spouse of Enlisted

Civilian

Child of parent connected with military

4.How long have you been stationed at McConnell?

1 - 6 months

7 - 11 months

1 - 2 years

3 - 4 years

over 5 years

5.Where do you live?

Base Housing

Off Base Housing

Enlisted Dormitory

Other (please specify)

6.Which of the following best describes your marital status?

Single - never been married

Significant Other

Married - spouse is civilian

Married - spouse is military member

Separated

Divorced

7.Are you geographically separated from your spouse, if yes where is your spouse currently stationed?

Yes

Place of Duty Station

8.Is your spouse employed in a job equal to his/her qualifications?

Yes

N/A

9.How many children live in your home? (if you have no questions skip to question 15)

None

1 Child

2 Children

3 Children

4 Children

5 or More

10.How many of your children are:

Biological

Step

Foster

Adopted

Other (please specify)

11.What are the ages of the children living with you? (Choose all that apply)

Newborn - 3 months

3 months - 6 months

6 months - 1 year

1 year - 3 years

3 years - 6 years

6 years - 11 years

11 years - 16 years

16 years - 20 years

20 years - 25 years

Age and relationship of other dependent children living with you?

12.What is the highest level of education you have attained?

High School

Certificate

Licensed

Some College

Associate Degree

Under Graduate Degree

Graduate Degree

13.What is the highest level of education your spouse has attained?