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* 1. What is Your Contact Information?

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* 2. What is your age?

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* 3. What is your Cultural Background or Race of Origin

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* 4. Did you grow up fatherless?
i.e. Father deprived, Alienated from Father, Every Other Weekend Custody/Parenting Time, Father Died, or not knowing your father at all.

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* 5. Do you have children with a partner you are no longer dating, currently separated, or divorced?

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* 6. How many children do you have?

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* 7. What are the Ages of Your Child(ren)?

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* 8. Do you have a Custody Order with Parenting Time/Established Paternity Rights?

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* 9. If yes to question #8, Is the Custody & Parenting Time Order Followed

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* 10. Do you have a Standard Parenting Time Order?

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* 11. How often do you see your children?

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* 12. What is your relationship like with your children at this time?

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* 13. When is the last time you've seen your child(ren)?

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* 14. What would your ideal relationship with your child look like?

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* 15. Do you currently have a Child Support Order?

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* 16. If yes to question #15, What percentage of your annual income do you pay in Child Support?

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* 17. Did you take a Paternity Test?

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* 18. Do you have any Child Support Arrearage?

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* 19. What is your Annual Salary?

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* 20. Do you consider yourself Unemployed or Underemployed?

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* 21. How has no time or lack of time with your children impacted your ability to perform at work?

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* 22. Has it caused you to lose any previous employment

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* 23. A lack of finances has made fatherhood difficult?

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* 24. What Emotional and Mental challenges have you faced due to your fight for fatherhood?

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* 25. Have you been labeled a "Deadbeat Dad?

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* 26. Have you experienced a Silver Bullet? i.e. False Allegations

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* 27. Have you seen a Therapist or Family Counselor concerning the impact fighting for fatherhood has had on you?

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* 28. Are you a long-distance father?

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* 29. If yes to question #28, who relocated?

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* 30. If yes to question #28, What is the time in a car it takes to get to your children?

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