Today's Family Experience Survey

Thanks for taking a few minutes to help us know you better and focus on content that helps you connect with your family. If you have ideas or suggestions that are hard to capture on a this survey please don't hesitate to call me at 360-690-8495 or email me at chagele@projectpathc.org.

Thanks for your help.

Chuck

Question Title

* 1. Feel free to share as much information about yourslef as you feel comfortable. We will protect your information.

Name:

Address:

Address 2:

City/Town:

State:

ZIP:

Email Address:

Phone Number:

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* 2. What role brings you to our content?

Parent

Grandparent

Mentor

Teacher

Therapist

Pastor

Other (please specify)

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* 3. What ages are the kids in your life?

0-2

3-5

6-8

9-12

13-15

16-18

19-22

23+

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* 4. What topics are you most interested in hearing more about?

	5 Very Interested	4	3 Neutral	2	1 Least Interested	NA
Discipline	Discipline 5 Very Interested	Discipline 4	Discipline 3 Neutral	Discipline 2	Discipline 1 Least Interested	Discipline NA
Values	Values 5 Very Interested	Values 4	Values 3 Neutral	Values 2	Values 1 Least Interested	Values NA
Technology - Internet	Technology - Internet 5 Very Interested	Technology - Internet 4	Technology - Internet 3 Neutral	Technology - Internet 2	Technology - Internet 1 Least Interested	Technology - Internet NA
Technology - Video Games	Technology - Video Games 5 Very Interested	Technology - Video Games 4	Technology - Video Games 3 Neutral	Technology - Video Games 2	Technology - Video Games 1 Least Interested	Technology - Video Games NA
Technology - Social Media	Technology - Social Media 5 Very Interested	Technology - Social Media 4	Technology - Social Media 3 Neutral	Technology - Social Media 2	Technology - Social Media 1 Least Interested	Technology - Social Media NA
Dating	Dating 5 Very Interested	Dating 4	Dating 3 Neutral	Dating 2	Dating 1 Least Interested	Dating NA
Passing on faith	Passing on faith 5 Very Interested	Passing on faith 4	Passing on faith 3 Neutral	Passing on faith 2	Passing on faith 1 Least Interested	Passing on faith NA
Mentoring	Mentoring 5 Very Interested	Mentoring 4	Mentoring 3 Neutral	Mentoring 2	Mentoring 1 Least Interested	Mentoring NA
Kid's Friends	Kid's Friends 5 Very Interested	Kid's Friends 4	Kid's Friends 3 Neutral	Kid's Friends 2	Kid's Friends 1 Least Interested	Kid's Friends NA
Bullying	Bullying 5 Very Interested	Bullying 4	Bullying 3 Neutral	Bullying 2	Bullying 1 Least Interested	Bullying NA
Teaching good habits	Teaching good habits 5 Very Interested	Teaching good habits 4	Teaching good habits 3 Neutral	Teaching good habits 2	Teaching good habits 1 Least Interested	Teaching good habits NA

Question Title

* 5. How familiar are you with programs offered by Project Patch?

	5 Very Familiar	4	3 Neutral	2	1 Not Familiar	NA
Youth Ranch for struggling teens	Youth Ranch for struggling teens 5 Very Familiar	Youth Ranch for struggling teens 4	Youth Ranch for struggling teens 3 Neutral	Youth Ranch for struggling teens 2	Youth Ranch for struggling teens 1 Not Familiar	Youth Ranch for struggling teens NA
Family Experience	Family Experience 5 Very Familiar	Family Experience 4	Family Experience 3 Neutral	Family Experience 2	Family Experience 1 Not Familiar	Family Experience NA
Seminars/Speaking	Seminars/Speaking 5 Very Familiar	Seminars/Speaking 4	Seminars/Speaking 3 Neutral	Seminars/Speaking 2	Seminars/Speaking 1 Not Familiar	Seminars/Speaking NA

Today's Family Experience Survey

Question Title

* 1. Feel free to share as much information about yourslef as you feel comfortable. We will protect your information.

Question Title

* 2. What role brings you to our content?

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* 3. What ages are the kids in your life?

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* 4. What topics are you most interested in hearing more about?

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* 5. How familiar are you with programs offered by Project Patch?

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* 6. What would you like to see us doing more of?

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* 7. Any other suggestions?

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* 8. Would you liked to be contacted to discuss this survey?