Question Title

* 1. INFORMED CONSENT

Title: Exploring the Experience of Being a Fatherless Daughter

Principal Investigators: Karin L. Smithson, Ph.D and Denna Babul, R.N.


Introduction
You are invited to participate in a 15 minute research study. The purpose of the study is to look at fatherless daughters' lives, exploring their social, emotional physical and relational development. You are invited to participate because you are a fatherless daughter. We will ask about your present and past developmental experiences as well as your hope for the future. Between 100-1,000 women will participate in this study.

Procedures
If you decide to participate, you will complete a one-time survey on a secure website. You will be asked to answer a series of questions. Your answers to these questions will be recorded on the website database but will remain confidential.

Risks
We expect this survey to help you think and reflect on your life. It is possible that participating in this study may cause you to become emotional. If you become emotionally upset and want to talk to a mental health professional, please contact the primary researcher, Dr. Karin L. Smithson. She can be reached at Karin@doctorkarin.com or 678-232-8700 for a referral. The primary researcher is the co-founder of The Fatherless Daughter Project. In cases of referral, you will pay for all related costs.

Benefits
Participation in this study may not benefit you personally, although we hope that you gain insight about your relationship with your father, family, and self. Mostly, we hope that you reach a higher, healthier level of self awareness. Overall, we hope to gain information about fathered and fatherless daughters to share with others.

Voluntary Participation and Withdrawal
Participation in this research is voluntary. You do not have to be in this study. You may refuse to participate at any time without penalty. You may stop or choose to not answer a question.

Confidentiality
All information you provide will be kept confidential, as permitted by the law. Dr. Karin Smithson and Denna Babul will have access to the information you provide.The information you provide will be stored on Karin Smithson’s password and firewall protected computer. You will not be identified personally. The findings will be summarized and reported in group form and will be included in our book and/or documentary, "Fatherless Daughters," and referenced as we speak on the subject through media or personal appearances.

Contact Persons
Please contact Dr. Karin L. Smithson (678-232-8700; Karin@doctorkarin.com) or Denna Babul (404-790-3152; DennaBabul@gmail.com) if you have questions about this study.

Copy of Consent Form to Subject:
You may download or print a copy of this consent form to keep. If you are willing to volunteer for this study, please check the box below.

Question Title

* 2. How old are you?

Question Title

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

Question Title

* 4. EWhat is your highest level of education?

Question Title

* 5. Which of the following best describes your current occupation?

Question Title

* 6. How did you become fatherless? My father ... (check all that apply)

Question Title

* 7. How old were you when your father passed away or became absent?

Question Title

* 8. What was your family's financial situation after your father was gone? (Check all that apply.)

Question Title

* 9. Please select any behavior or substance, if any, that you might have struggled with (or became addicted to) after your father loss (check all that apply).

Question Title

* 10. Please select the challenging ways, if any, that you believe your fatherlessness affected your life (check all that apply).

Question Title

* 11. Please select the way(s), if any, that you have tried to cope with the loss of your father, if any.

Question Title

* 12. Please select the people, if any, that have helped you cope with your loss in a positive way (check all that apply).

Question Title

* 13. Please select any positive things that you did to cope with the loss of your father (select all that apply).

Question Title

* 14. If your father is still alive, do you wish to connect with him?

Question Title

* 15. If you have been engaged, how many times?

Question Title

* 16. If you have been married or partnered, how many times?

Question Title

* 17. Do you believe that your father loss has affected your decisions about intimacy/sex?

Question Title

* 18. Are you a mother?

Question Title

* 19. If you have children, has your father loss affected you as a mother?

Question Title

* 20. Please select the positive things you have gained in your life, if any, despite your loss (check all that apply).

Question Title

* 21. What would you say to your Dad if you could? (Check all that apply.)

Question Title

* 22. What are some days, if any, that have been difficult for you since your father left? (Check all that apply.)

Question Title

* 23. If you had siblings, how did your father's absence affect your relationship, if at all? (check all that apply)

Question Title

* 24. If your father is still alive, did he remarry?

Question Title

* 25. My father loss:

Question Title

* 26. When, if at all, did you realize how your father loss was affecting your life? (Check all that apply.)

Question Title

* 27. How often do you think about your father loss?

Question Title

* 28. How, if at all, did your relationship with your mother change when your father died / left?

Question Title

* 29. What areas of your life, if any, were impacted by the loss of your father? (check all that apply)

Question Title

* 30. How would you describe your relationship with your mother now?

Question Title

* 31. Where are you on grieving the loss of your father, if at all?

Question Title

* 32. Have you received therapy, counseling or life coaching for issues related to your father loss?

Question Title

* 33. How well did/do you know your father? (likes, dislikes, personality, history, etc.)

Question Title

* 34. How often do you see, or talk to, your father's side of the family?

Question Title

* 35. Do you think that you have a fear of commitment?

Question Title

* 36. Are you the breadwinner of your family?

Question Title

* 37. Have you ever tested a man by leaving him to see if he will come back for you?

Question Title

* 38. How would you describe yourself now? (Check all that apply.)

Question Title

* 39. Do you feel like you would have accomplished more in your life if your Dad was around for it?

Question Title

* 40. How have you learned things about your father (check all that apply)?

Question Title

* 41. If you had a 'stand in' father figure in your life, who was it?

Question Title

* 42. Do you consider your father a 'good man?'

Question Title

* 43. If you answered "No" to the previous question, do you feel guilt or shame not considering your Dad a 'Good Man?'

Question Title

* 44. Have you ever taken care of your Mother financially?

Question Title

* 45. Have you ever taken care of your mother emotionally?

Question Title

* 46. When your father became absent, did your mother turn to you as more of a friend than a daughter for a time?

Question Title

* 47. Does/did your mother seem to make good choices regarding relationships with men?

Question Title

* 48. Do you have a deeper understanding today of what your mother went through when she lost your father?

Question Title

* 49. Does, or did, your Mom speak poorly about your Dad, if at all?

Question Title

* 50. Do you think that you have anger issues?

Question Title

* 51. Do you tend to be the one that friends turn to for advice?

Question Title

* 52. Do you consider yourself aggressive or headstrong?

Question Title

* 53. Do you have friends that you feel are more like family?

Question Title

* 54. How did/do you know that your Dad loved you?

Question Title

* 55. What do you do on Father's Day? (Select all that apply.)

Question Title

* 56. Do you feel like it takes you longer than most to get over a broken heart?

Question Title

* 57. How have you learned to set standards & boundaries in opposite sex relationships? (select all that apply.)

Question Title

* 58. What are you most afraid of?

Question Title

* 59. What one word or phrase would you use to describe yourself today?

Question Title

* 60. What goal do you have for your life and happiness?

T