Thank you for completing this survey. This information helps us complete our reports regarding who has received mediation services. Your name is not used in this survey. In all questions regarding income, there is no association between the dollar amount reported here and possible child support payments. 

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* 1. My custody of the child(ren) BEFORE MEDIATION is

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* 2. As regards to the child(ren) IN THIS MATTER, I am

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* 3. Where I live, the number of the people in the household is

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* 4. My YEARLY income is

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* 5. I estimate the COMBINED YEARLY HOUSEHOLD INCOME BEFORE TAXES to be

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* 6. My ethnicity is 

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* 7. I am receiving Temporary Assistance for Needy Families

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* 8. I filled out an application to open a case with Division of Child Support Enforcement, had a case opened, and haven't closed it. (If so, mark "yes").

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* 9. For PARENTS ONLY - My relationship to the child(ren)'s other parent:

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* 10. Please enter your ZIP code. 

0 of 10 answered
 

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