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* 1. How did you hear about this?

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* 2. Your Name and Age

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* 3. Today's Date

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* 4. Mailing Address (for program materials)

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* 5. Email Address (for Zoom invitation)

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* 6. Ages of All Your Children (whether in your home or not)

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* 7. Please choose the response that best describes how you honestly feel. In an overall sense, how difficult has your child's behavior been over the last 6 weeks?

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* 8. To what extent do these statements describe your experience as a parent in the last 6 weeks?
a.) Parenting is rewarding

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* 9. b.) Parenting is demanding.

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* 10. c.) Parenting is stressful.

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* 11. d.) Parenting is fulfilling.

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* 12. e.) Parenting is depressing.

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* 13. In the last 6 weeks, how confident have you felt to undertake your responsibilities as a parent?

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* 14. How supported have you felt in your role as a parent over the last 6 weeks?

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* 15. If you have a partner, to what extent do you both agree over methods of disciplining your child?

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* 16. Are you willing to complete a shorter survey 2 weeks after this workshop?

T