* The following demographic information is optional.

* This information will be used to better serve you and your family.

2. What is the age range of your son(s)? Please check all that apply

* 3. Below are 5 concerns that have been expressed by single mothers raising boys across the country, and we would like to know what concerns you most.

On a scale of 1 to 5 please rate the following concerns.
1 being the least concern and 5 being the greatest concern.

  Extremely Important Very Important Mildly Important Somewhat Important Not Important N/A
Academic Achievement
Father Involvement
Finding Male Mentors
Peer Pressure
School Environment
Finances
Day Care/Child Care
Other (please specify)

* 4. Please specify if you stated other in the previous question:

* 5. Do you feel that your son has a positive male role model? (Ex. Other family members, teachers, mentors etc.)

* 6. Are there free or affordable after school activities and resources available for your son in your community? (Recreation Center, Sports Team, clubs, etc.)

* 7. Do you have free/personal time to do something for yourself (Ex. relaxing, exercise, hobby). If not, how does this effect your daily life?

* 8. Do you have any concerns about your housing or neighborhood? (Crime, Gang Activity, etc.)

* 9. During these troubling economic times are you and your son's basic needs being met? Such as (food, clothes, etc.)

* 10. How would you rate your son and his father's relationship?

  N/A
Exceptional
Great
Okay
Non-existant

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