Thank you again for participating in this landmark study! All your responses will be confidential and anonymous.

In order to set a framework for your answers we request that you follow this general instruction. If you have more than one child, which is most common, please generalize your response, even though the question may specify “your child”. In other words we want your response to be a general representation of your fathering.

Some of the statements focus on a specific developmental stage of your child. If your children have progressed beyond that stage of life, reflect back on how you fathered them during that time. If your child is too young to give a response to the statement, for example, I know my child’s teachers and my child is not school age yet, then mark NA (Not Applicable)

All the statements and questions are randomized so read each one carefully.

In response to the following statements how would you evaluate your fathering? 1=strongly disagree 2=disagree 3=mixed 4=agree 5=strongly agree 6=NA-Not applicable

Question Title

* 1. In response to the following statements how would you evaluate your fathering?

  Strongly Disagree Disagree Mixed Agree Strongly Agree N/A
I am patient with my child.
My child's mother and I work together as a team.
Being a father has been a joy for me.
I am actively involved in helping my child develop his/her spiritual life.
I can easily lose my cool during a conflict.
My child feels loved and valued by me.
There have been many crises in our family which have affected my child.
I have had discussions with my child about the effects of drugs, sex and media appropriate to their age.
I know how to resolve conflicts with my child.
I have a close relationship with my child.
My child is in control of his/her emotions most of the time.
I had an excellent childhood.
I know when my child is down or discouraged.
When I have a disagreement or a fight with my child I consciously seek to repair the problem.
I have reached out to help or encourage one of my child's friends.
I compliment my child often.
I treat and father all my children the same.
I regularly review what my child is learning outside the home.
I know the names of my child's close friends.
I can read my child's facial expressions and body language.
Disciplining my child has been very difficult for me.
My child's personality is more like mine than his/her mothers.
My child has good self-esteem.
I am very predictable in the way I relate to my family.
My child's mother and I can comfortably laugh at ourselves.
In our home we can calmly discuss our differences.
I tell my child that I love him/her often.
Boys are more difficult to father than girls.
Our family has had serious financial challenges in recent years.
I have fond memories of my childhood.

Question Title

* 2. What inspires, or has inspired you to become a better father?

Rank from highest importance to lowest (1-7) the following items related to your fathering. When rating a particular item, a drop down box will appear so that you can assign it a respective level of importance. The survey will automatically move that item to its corresponding placement on the list after you have assigned its placement. Continue until all items have been assigned in their order of importance and the list will be complete. You can then continue to the next question.

Question Title

* 3. Which of these virtues do you consider most important to your fathering right now?

Question Title

* 4. Rank these barriers in order of their significance to your fathering.

Question Title

* 5. Which of these best describes your ethnicity?

Question Title

* 6. What is your age?

Question Title

* 7. How many children do you have?

Question Title

* 8. How many sons?

Question Title

* 9. How many daughters?

Question Title

* 10. How many children currently live in your home?

Question Title

* 11. What is the age of your oldest child?

Question Title

* 12. What are some of your hopes and goals for your children and family?

Question Title

* 13. In order of importance how would you rate the following priorities in your fathering today? (1 Highest Importance - 8 Lowest Importance )

Question Title

* 14. How satisfied are you in each of the following areas?

  Extremely Dissatisfied Very Dissatisfied Somewhat Dissatisfied Mixed Somewhat Satisfied Very Satisfied Extremely Satisfied
How satisfied are you as a father?
How satisfied are you with how much your children talk to you?
How satisfied are you with your marriage or relationship to your child's mother?
How satisfied were you with your childhood?
How satisfied are you with your relationship with your children?
How satisfied are you with your job?
How satisfied are you with the support you receive from others in being a good father?
How satisfied are you with your life?
How satisfied were you with your relationship with your father growing up?
How satisfied are you with your child's behavior?
How satisfied are you with your family life?

Question Title

* 15. What is the biggest challenge or issue you are facing in your fathering?

Question Title

* 16. Approximatley how often does your family have a meal together?

Question Title

* 17. How active are (or were) you in your child's education?

Question Title

* 18. Do any of these apply to you? Yes or No.

  Yes No
Have a child with special needs
Have an adopted child
Have lost a child due to death
Have experienced divorce
My parents have divorced
I have been unemployed over a year
I have significant health issues
I have step child(ren)
Moved our household three times or more in the past two years
Been to counseling for personal, marital or family problems in the past five years

Question Title

* 19. How would you rate your family interactions when you were growing up?

Question Title

* 20. As a child, did you experience any of the following growing up?

  Yes No
Parents' divorce
Substance abuse
Sexual abuse
Physical abuse
Emotional/Mental abuse
Sibling or Parent death

Question Title

* 21. Which category most accurately reflects your current total family income?

Question Title

* 22. Have you experienced any of these in the past 3 months?

Question Title

* 23. What are the most pressing problems your child(ren) is/are facing?

Question Title

* 24. What is your current marital status?

Question Title

* 25. What is the highest level of education you have completed?

Question Title

* 26. How many hours do you work per week?

Question Title

* 27. If married, does your spouse work outside the home?

Question Title

* 28. How would you rate your current health in the following areas?

  Poor Fair Good Excellent
Physical
Mental
Spiritual
Emotional
Social
Financial
Family

Question Title

* 29. What could the Fathering CoMission do to assist you in becoming a better father?

Question Title

* 30. In response to the following statements, how would you evaluate your fathering?

  Strongly Disagree Disagree Mixed Agree Strongly Agree N/A
I know how my child compares to other children developmentally
I spend individual time with each of my children
I tend to overwhelm my child when we are together
We follow regular schedules and routines in our household
My child has difficulty in obeying me and/or his/her mother
I have disagreements with my child's mother that are not helpful
I frequently express joy to my child
I pray with and for my child regularly
I know my child's greatest fears
We have a peaceful environment in our home
I am good at caring for my child
My child has heard me say I am sorry more than once in our home
I know how to soothe my child
I am in sync with my child's feelings
I regularly express a deep appreciation for my child's mother
My child knows how to use money properly
My child is mature beyond his/her years
I get easily upset when my child does something with which I do not agree
I have established a code of conduct for my child
I have frequent conflict with my child
I know my child's strengths and weaknesses in learning
My child respects me and his/her mother
We have a weekly family time together
I push my child to excel in all his/her activities
Girls are more difficult to father than boys
I regularly meet with a group of men
I have some habits and behaviors that I do not want to pass on to my children
I talk openly with my children about their spiritual concerns
I am comfortable with hugging and touching my child
I have a strong willed child.

Question Title

* 31. Enter your email address here if you would like to receive a copy of the executive summary.

T