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COBT

PLEASE ONLY COMPLETE THIS SURVEY IF YOU ARE A CURRENT RESIDENT OF THE UNITED STATES OR CANADA.
Please fill out this survey if your child is an adolescent age 11 to 19. If you have more than one adolescent, please select the adolescent whose name comes first in the alphabet. (For example, if your adolescents' names are Moshe, Chana, and Rachel, you would answer the survey about Chana.)

This survey should require no more than one half hour to complete. We appreciate your help in providing us with valuable information regarding how to best serve your community.
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1. CONFIDENTIALITY:
This survey is completely anonymous and you will not be identified in any way.
2. PURPOSE:
This survey is designed to learn more about adolescent adjustment in the families of Orthodox Jews and determine how communities may better meet the mental health needs of Orthodox Jewish families.
3. RISKS: No significant risks are anticipated. There is some possibility that answering some of the questions may make you feel uncomfortable.
4. BENEFITS: Although there may be no direct benefits of participating in this research, the results may be of significant assistance in determining effective ways to address the mental health needs of the Orthodox Jewish community.
5. OPTIONS: Your participation is voluntary and you may withdraw at any time.
1.Gender of child
2.Relationship of person filling out survey to the child.
3.What is your highest level of education?
4.What is your profession?
5.In your immediate family, what best describes the current family unit where your child spends at least 50% of his or her time?
6.Number of siblings currently living in the home where the child spends at least 50% of his or her time (including step and half siblings).
7.What is the current sibling rank of the child?
8.What is the total number of biological siblings regardless of where they currently reside?
9.Were you born Jewish?
If you answered "No," please skip to Question #11.
10.Do you consider yourself to have been religiously observant from birth (frum from birth)?
If you answered "YES," please go to question 15 to continue with the survey.
11.At what age did YOU become observant?
12.At what point in your life did you become observant?
13.What level of observance did you have before becoming observant?
14.My parents support my religious choices.
15.How would you best describe the community in which you live?(Required.)
16.How would you describe yourself?(Required.)
17.Do you have a rabbi you can turn to when necessary?
18.How often do you and your spouse experience conflict with each other over differences in religious observance?