1. Default Section

* 1. The following demographic information is optional.

* 2. What is the age range of your son(s)? Please check all that apply

* 3. Below are 5 concerns that have been expressed by single mothers raising boys across the country, and we would like to know what concerns you most.On a scale of 1 to 5 please rate the following concerns. 1 being the least concern and 5 being the greatest concern.

  1 2 3 4 5
Academic Achievement
Father Involvement
Finding Male Mentors
Peer Pressure
School Environment
Finances
Day Care/Child Care

* 4. Do you feel that your son has a positive male role model? (Ex.Other family members, teachers, mentors,etc.)

* 5. Are there free or affordable after school activities and resources available for your son in your community? (Recreation Center, Sports Team, clubs, etc.)

* 6. Do you have free/personal time to do something for yourself (Ex. relaxing, exercise, hobby). If not, how does this effect your daily life?

* 7. Do you have any concerns about your housing or neighborhood? (Crime, Gang Activity, etc.)

* 8. What kinds of support/activities would you like to receive from your son's school related to academic achievement?

* 9. During these troubling economic times are you and your son's basic needs being met? Such as (food, clothes, etc.)

* 10. How would you rate your son and his father's relatioship?

T