Quarter 3 Demographic 2019-2020 Survey

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* 1. Class title?

Video 1: What is Anxiety and How to manage it?

Video 2: Two paths to an anxiety proof family

Video 3: Powerful Resilient Families

Video 4

Video 5

Other (please specify)

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* 2. Please mark the appropriate choice:

Parent

Professional

Professional & Parent

Other (please specify)

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* 3. What is your zip code?

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* 4. What is your age group?

0-15

16-25

26-59

60+

Decline to State

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* 5. Gender assigned at birth

Male

Female

Decline to State

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* 6. Current Gender Identitiy

Male

Female

Transgender

Genderqueer

Questioning or Unsure

Another Gender Identity

Decline to State

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* 7. What is your race?

American Indian or Alaskan Native

Asian

Black or African American

Native Hawaiian or other Pacific Islander

White/Caucasian

Other

More than one race

Decline to State

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* 8. What is your ethnicity?

Caribbean

Central American

Mexican/Mexican-American/Chicano

Puerto Rican

South American

African

Asian Indian/South Asian

Cambodian

Chinese

Eastern European

European

Filipino

Japanese

Korean

Middle Eastern

Vietnamese

Other

Multi-Racial

Decline to State

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* 9. Sexual Orientation

Gay or Lesbian

Heterosexual or Straight

Bisexual

Questioning or Unsure

Queer

Another Sexual Orientation

Decline to Anser

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* 10. What is your home language?

English

Spanish

Other (please specify)

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* 11. How many children do you have?

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* 12. What are the ages of your children?

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* 13. Select all that apply:

Vision Impaired

Hearing Impaired

Physical Mobility

Chronic Health Condition

Other Disasbility

Open CWS Case or Required to take a class

Veteran

Homeless

None of these apply to me.

Other (please specify)

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* 14. How much schooling have you had?

No high school

High School Diploma

Bachelor's Degree

Some high school

Associate degree

Graduate Degree

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* 15. What is your yearly income?

0-20,999

21,000-35,999

36,000-49,999

50,000-74,999

75,000-99,999

100,000 or more

Quarter 3 Demographic 2019-2020

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* 1. Class title?

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* 2. Please mark the appropriate choice:

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* 3. What is your zip code?

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* 4. What is your age group?

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* 5. Gender assigned at birth

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* 6. Current Gender Identitiy

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* 7. What is your race?

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* 8. What is your ethnicity?

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* 9. Sexual Orientation

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* 10. What is your home language?

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* 11. How many children do you have?

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* 12. What are the ages of your children?

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* 13. Select all that apply:

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* 14. How much schooling have you had?

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* 15. What is your yearly income?

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* 16. If you would like to stay connected with Parent Connection of San Luis Obispo County please leave your name & email below:

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* 17. Would you like a Parent Coach to contact you? Leave your name and number for someone to follow up with you:

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* 18. Do you have any questions or comments for us?

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* 19. What was your favorite part of the video?