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Please take this class survey. This helps us evaluate effectiveness of the class and will ensure that you receive a certificate of completion. Please let us know if you have any questions. Thank you!

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* 1. First Name

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* 2. Last Name

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* 3. Survey Completed:

Date
Your responses to this survey are confidential. If you need assistance completing the form, please ask a member of the staff. Please think back to when you started this program. For each of the following items, mark the first row based on how you felt or what you experienced BEFORE you started the program. On the second row, respond based on how you feel or what you experience NOW.

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* 4. The future looks good for our family.

  Mark how you felt or what you experienced BEFORE you started the program and NOW
Before
Now

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* 5. In my family, we take time to listen to each other.

  Mark how you felt or what you experienced BEFORE you started the program and NOW
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Now

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* 6. There are things we do as a family that are special just to us.

  Mark how you felt or what you experienced BEFORE you started the program and NOW
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* 7. My child misbehaves just to upset me.

  Mark how you felt or what you experienced BEFORE you started the program and NOW
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Now

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* 8. I feel like I’m always telling my kids “no” or “stop.”

  Mark how you felt or what you experienced BEFORE you started the program and NOW
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Now

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* 9. I have frequent power struggles with my kids.

  Mark how you felt or what you experienced BEFORE you started the program and NOW
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* 10. How I respond to my child depends on how I’m feeling.

  Mark how you felt or what you experienced BEFORE you started the program and NOW
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* 11. I have people who believe in me.

  Mark how you felt or what you experienced BEFORE you started the program and NOW
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Now

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* 12. I have someone in my life who gives me advice, even when it’s hard to hear.

  Mark how you felt or what you experienced BEFORE you started the program and NOW
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* 13. When I am trying to work on achieving a goal, I have friends who will support me.

  Mark how you felt or what you experienced BEFORE you started the program and NOW
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* 14. When I need someone to look after my kids on short notice, I can find someone I trust.

  Mark how you felt or what you experienced BEFORE you started the program and NOW
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* 15. BEFORE - I have people I trust to ask for advice about (check all that apply):

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* 16. NOW - I have people I trust to ask for advice about (check all that apply):

The following questions are about your experiences so far in this program or organization. Your answers to these questions can help staff improve services for you and others like you, so it’s important you answer honestly. For each of the following items, mark the first row based on how you felt or what you experienced BEFORE you started the program. On the second row, respond based on how you feel or what you experience NOW.

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* 17. I feel like staff here understand me.

  Mark how you felt or what you experienced BEFORE you started the program and NOW
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* 18. No one here seems to believe that I can change.

  Mark how you felt or what you experienced BEFORE you started the program and NOW
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* 19. When I talk to people here about my problems, they just don’t seem to understand.

  Mark how you felt or what you experienced BEFORE you started the program and NOW
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Now
Please continue answering the questions in the next section.
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