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Single Mom Resource Course Intake Survey- Spring 2021
1.
Your Name
2.
Email Address
3.
Would you like us to add you to our Kaleo Family newsletter list?
I'm all subscribed and already part of the Fam!
Yes please! I don't want to miss out on all Kaleo Family perks!
Not at this time.
4.
How would you rate your knowledge of the resources in your community that you can access?
Very Low
Low
Medium
High
Very High
5.
How would you rate your time management skills?
Very low
Low
Medium
High
Very High
6.
I use time blocking to manage my time
Regularly
Sometimes
Never
7.
I understand the benefits of regular journaling.
Strongly agree
Agree
Disagree
Strongly disagree
8.
How often do you journal?
Never
Very Infrequently
Weekly
Daily
Multiple Times per Day
9.
I know how to create and track a budget.
Strongly agree
Agree
Disagree
Strongly disagree
10.
Do you use a budget for personal and/or household expenses?
Yes
No
Sometimes
11.
How often do you plan your meals in advance?
On a regular basis (daily or weekly)
Sometimes
Not at all
12.
I know how to make a meal plan.
Strongly agree
Agree
Disagree
Strongly disagree
13.
I have strategies to build healthy habits
Strongly agree
Agree
Disagree
Strongly disagree
14.
I have created healthy habits for myself
Strongly agree
Agree
Disagree
Strongly disagree
15.
I am taking steps to get me closer to my goals and vision.
Strongly agree
Agree
Disagree
Strongly disagree
16.
I understand the connection between my mental and physical well being.
Strongly agree
Agree
Disagree
Strongly disagree
17.
I take steps to manage my stress.
Strongly agree
Agree
Disagree
Strongly disagree
18.
How often do you engage in creative activities with your children?
Daily
Weekly
Monthly
Very infrequently
19.
I understand the importance of creative play.
Strongly agree
Agree
Disagree
Strongly disagree
20.
I have a vision for my future and I am confident I can achieve it.
Strongly agree
Agree
Disagree
Strongly disagree
21.
I am aware of steps I can take to improve my life.
Strongly agree
Agree
Disagree
Strongly disagree
22.
I believe in my capability to take action and improve my life.
Very satisfied
Satisfied
Dissatisfied
Very dissatisfied
Current Progress,
0 of 22 answered