Childhood Conversations Conference Evaluation 2016

Demographic Information

Please tell us a bit about yourself.

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* 1. In what city do you live?

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* 2. What is your race? Mark one or more.

White

Black or African American

Asian

Native Hawaiian or Other Pacific Islander

American Indian or Alaska Native

Other

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* 3. What is your gender?

Female

Male

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* 4. What is your workshop participation status?

Parent

Student

Professional

If Professional, please add your position

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* 5. What is your Parenting Status? (Check all that apply)

Parent

Foster Parent

Adoptive Parent

Grandparent

Not a Parent

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* 6. Please note the number of children you care for / are raising for each age group.

	0	1-2	3-9	10+
Infants	Infants 0	Infants 1-2	Infants 3-9	Infants 10+
Toddlers	Toddlers 0	Toddlers 1-2	Toddlers 3-9	Toddlers 10+
Preschoolers	Preschoolers 0	Preschoolers 1-2	Preschoolers 3-9	Preschoolers 10+
School Age	School Age 0	School Age 1-2	School Age 3-9	School Age 10+
Pre-teen	Pre-teen 0	Pre-teen 1-2	Pre-teen 3-9	Pre-teen 10+
Teen	Teen 0	Teen 1-2	Teen 3-9	Teen 10+