Pre-Test - NP All Ages

Please take this parenting assessment. 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. Date Survey Was Taken (Required.)

Today's Date

Date

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2. First Name (Required.)

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3. Middle Initial (Required.)

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4. Last Name (Or ID): (Required.)

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5. Birthday (Required.)

Please enter your birthday

Date

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6. Gender: (Required.)

Male

Female

Transgender Man

Transgender Woman

Non-binary

Other (please specify)

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7. Race/Nationality: (Required.)

White

Black

Asian

Hispanic

Native American

Pacific Islander

Bi-racial

Multi-racial

Other

Nationality:

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8. Marital Status: (Required.)

Single

Married

Unmarried Partners

Separated/Divorced

Widow/Widower

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9. Number of children you have: (Required.)

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10. Highest grade you completed: (Required.)

Grade School

Middle School (grades 7 & 8)

Some High School (grades 9 -11)

High School Graduate

Working on OR Completed GED

Two Year Tech School

Some College

College Graduate

Post Graduate or above

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11. Current Employment-School status: (Required.)

Employed full-time

Going to school full-time

Employed part-time

Going to school part-time

Both going to school and working

I am a stay at home parent

Currently unemployed and not going to school

Retired

Other

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12. Annual Household Income (estimate): (Required.)

Under $15,000

$15,001 to $25,000

$25,001 to $30,000

$30,001 to $40,000

$40,001 to $60,000

Over $60,000

I don’t know

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13. Are/were you or your partner in the military? (Required.)

Yes, only me

Yes, only my partner

Yes, both of us

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14. As a child, did you experience any type of physical, emotional or sexual abuse by someone outside your family? (Required.)

Yes

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15. As a child, did you experience any type of physical, emotional or sexual abuse by someone inside your family? (Required.)

Yes

Pre-Test - NP All Ages

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* 1. Date Survey Was Taken (Required.)

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* 2. First Name (Required.)

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* 3. Middle Initial (Required.)

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* 4. Last Name (Or ID): (Required.)

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* 5. Birthday (Required.)

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* 6. Gender: (Required.)

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* 7. Race/Nationality: (Required.)

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* 8. Marital Status: (Required.)

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* 9. Number of children you have: (Required.)

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* 10. Highest grade you completed: (Required.)

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* 11. Current Employment-School status: (Required.)

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* 12. Annual Household Income (estimate): (Required.)

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* 13. Are/were you or your partner in the military? (Required.)

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* 14. As a child, did you experience any type of physical, emotional or sexual abuse by someone outside your family? (Required.)

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* 15. As a child, did you experience any type of physical, emotional or sexual abuse by someone inside your family? (Required.)

1. Date Survey Was Taken (Required.)

2. First Name (Required.)

3. Middle Initial (Required.)

4. Last Name (Or ID): (Required.)

5. Birthday (Required.)

6. Gender: (Required.)

7. Race/Nationality: (Required.)

8. Marital Status: (Required.)

9. Number of children you have: (Required.)

10. Highest grade you completed: (Required.)

11. Current Employment-School status: (Required.)

12. Annual Household Income (estimate): (Required.)

13. Are/were you or your partner in the military? (Required.)

14. As a child, did you experience any type of physical, emotional or sexual abuse by someone outside your family? (Required.)

15. As a child, did you experience any type of physical, emotional or sexual abuse by someone inside your family? (Required.)