About You

Thank you for helping us with this listening survey. The information you provide will help people working in your community design local training and programs to help families stay healthy during and after pregnancy. 

This survey asks for some information about you. We will combine the information from all the people who participate in the focus groups, to understand their overall background. 


PLEASE DO NOT write your name on this survey. Your information is confidential, and you can skip any questions that you do not want to answer.

Question Title

* 1. How old are you?

Question Title

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

Question Title

* 3. How do you describe yourself? (select one or more answers)

Question Title

* 4. How many children do you have? 

Question Title

* 5. How many adults and children are living in your home right now?

Question Title

* 6. What county do you live in?

T