Parents Of COTOD Survey

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* 1. In regard to the child(ren) you are raising, who are you to them?

Mother

Father

Grandparent

Other (please specify)

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* 2. What is the age of your child(ren)? Choose all that apply.

Newborn-1 years old

2-3 years old

4-6 years old

7-9 years old

10-14 years old

15-18 years old

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* 3. Do you feel comfortable helping your child(ren) develop in their relationships?

Yes

Somewhat

A Little

Not At All

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* 4. Do you feel capable of dealing with your child(ren) emotions?

Yes

Somewhat

A little

Not At All

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* 5. How much time do you spend time with child(ren) a week?

15-20+ hours

10-15 hours

6-10 hours

0-5 hours

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* 6. How often do you give in to your child(ren)'s wants?

Always

Very Often

Sometimes

Rarely

Never

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* 7. Who do you feel supported by?

Family

friends

church

community/neighbors

others

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* 8. How often during a week do you sit and have dinner together?

5-7 days

2-4 days

1 day

Never

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* 9. Do your children have chores or task around the house?

Yes

Sometimes, Don't follow through

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* 10. Do you feel you struggle with punishment and following through when it's needed?

True

Sometimes

False

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* 11. What are your biggest fears for your child(ren)?

Addictions

Injuries

Lack of ambitions

Their Future

Kidnapping or assault

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* 12. As a parent/guardian what are your struggles? Choose all that apply.

Time Away

discipline

Navigating technology and media

navigating your and their schedule(s)

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* 13. How often do you fight in front of your child(ren)?

Very Often

Sometimes

Rarely

Never