Fatherhood After the Breakup, Separation, or Divorce Survey

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* 1. What is Your Contact Information?

First Name ONLY *

City/Town *

State/Province *

ZIP/Postal Code *

Country *

Email Address *

Phone Number

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* 2. What is your age?

18 to 24

25 to 34

35 to 44

45 to 54

55 to 64

65 to 74

75 or older

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

White or Caucasian

Black or African American

Hispanic or Latino

Asian or Asian American

American Indian or Alaska Native

Native Hawaiian or other Pacific Islander

Another race

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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.

Yes

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

Yes

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* 6. How many children do you have?

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

0 to 1

2 to 5

6-11

12-17

18+

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

Yes

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

Yes

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

Yes

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* 11. How often do you see your children?

Every other weekend, Summers, and Alternating Holidays

Just Holidays or Alternating Holidays

When the Custodial Parent Allows Me

Alienated

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

Great

Good

Satisfactory

Fair

Horrible

Alienated

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

6 months ago

1 year ago

2 years ago

More than 2 years ago

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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?

Yes

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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?

Yes

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* 18. Do you have any Child Support Arrearage?

Yes

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* 19. What is your Annual Salary?

Under $15,000

Between $15,000 and $29,999

Between $30,000 and $49,999

Between $50,000 and $74,999

Between $75,000 and $99,999

Between $100,000 and $150,000

Over $150,000

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* 20. Do you consider yourself Unemployed or Underemployed?

Yes

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

A great deal

A lot

A moderate amount

A little

None at all

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

Yes

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

Strongly agree

Agree

Somewhat agree

Neither agree nor disagree

Somewhat disagree

Disagree

Strongly disagree

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

Depression

Anxiety

Anger

Suicidal Thoughts/Attempts

PTSD

Shame

Guilt

All of the Above

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

Yes

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

Yes

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

Yes

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* 28. Are you a long-distance father?

Yes

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

You

Other Parent

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

1-3 Hours

3-6 Hours

6+ Hours

Fatherhood After the Breakup, Separation, or Divorce

Question Title

* 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?

* 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.