Aloha at Home ʻOhana Box #1: Getting to Know You

Mahalo for your participation in our ‘Ohana Box #1. We would appreciate you filling out this survey so we can get to know your ʻohana and help us create more ʻohana boxes.

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* 1. What do you do together as a family? (Select all that apply)

	All the time	Sometimes	Hardly ever
Play games together	Play games together All the time	Play games together Sometimes	Play games together Hardly ever
Work on projects together	Work on projects together All the time	Work on projects together Sometimes	Work on projects together Hardly ever
Prepare and/or eat meals together	Prepare and/or eat meals together All the time	Prepare and/or eat meals together Sometimes	Prepare and/or eat meals together Hardly ever
Watch TV/Movies together	Watch TV/Movies together All the time	Watch TV/Movies together Sometimes	Watch TV/Movies together Hardly ever
Do chores together	Do chores together All the time	Do chores together Sometimes	Do chores together Hardly ever
Read a book together	Read a book together All the time	Read a book together Sometimes	Read a book together Hardly ever

Other (please specify)

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* 2. Please provide your first and last name.

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* 3. What is your email address?

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* 4. How many people currently live in your household?

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* 5. What is your age?

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* 6. How many children, by age, currently live in your household? (Please use a number.)

Less than 1 year old

1-2 years old

3-5 years old

6-10 years old

11-13 years old

14-17 years old

18 years old or older

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* 7. How many kūpuna live in your household including you (age 60+)?

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* 8. What is your ZIP code? (enter 5-digit ZIP code)

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* 9. What is your ethnicity? (Please select all that apply.)

American Indian or Alaskan Native

Black or African American

Asian

Pacific Islander

Native Hawaiian

Hispanic or Latino

White / Caucasian

Prefer not to answer

Other (please specify)

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* 10. To which gender do you most identify?

Female

Male

Transgender Female

Transgender Male

Gender Variant/Non-conforming

Prefer not to answer

Self-describe:

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* 11. Which of the following best describes your current relationship status?

Married

Widowed

Divorced

Separated

In a domestic partnership or civil union

Single, but cohabiting with a significant other

Single, never married

Prefer not to answer

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

Did not attend school

Some high school

Graduated from high school

Trade school

Some college

Completed college

Completed graduate school

Prefer not to answer

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* 13. How were you referred to Aloha at Home ʻOhana Boxes?

Social service organization

Education organization

Community event

Aloha at Home team member

Other (please specify)

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* 14. Please check all the ways you are involved in Aloha at Home?

Visited our website: Alohaathome.org

Stopped by our Aloha at Home booth at a community event

Received an Aloha at Home ʻOhana box

Attended a presentation on Aloha at Home

Other (please specify)

None of the above

Mahalo for your time! Your responses have been recorded.