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* 1. I am...

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* 2. How do you identify your gender?

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* 3. Do any of the following describe your family's structure?

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* 4. Rate how you feel about the following statements:

  Yes Kind of Not really No
I feel comfortable walking into this agency
I see pictures or posters that are representative of me around the agency
I feel welcomed by front desk staff
I am given a meaningful role in my child's service plan
I feel comfortable spending time in this agency's waiting room
There's someone here I feel comfortable asking for help
I feel comfortable talking to staff

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* 5. I know about or would be interested in the following resources and events

  I know this exists at this agency I want to see this happen/increase
Arts & Crafts with Dad
Father's Day event
Celebrating Dad's birthday
Movie Day with Dad
Community service with Dad
Posters or pictures of fathers
Fatherhood information board
Quotes about the importance of Fatherhood
Male staff at the agency

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* 6. If any of the following is a barrier for you, recommend something the agency could do about it:

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* 7. What's the most important thing the agency could do to engage fathers or promote fatherhood?

T