Education Demographics Survey

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0

Child's name
0

Relationship to child
0

Highest education
0

Occupation
0

What are your family dynamics? Check where appropriate.
Single parent (divorced)

Single parent (widowed)

Double parent (heterosexual)

Double parent (LGBTQUIA)

Adoptive parents
0

What is your occupation?
0

If applicable, what is your spouse or partner's occupation?
0

What is your current gross annual household income?
< $3,000

$3,001 - $5,000

$5,001 - $7,500

$7,501 - $10,000

> $10,000
0

How many siblings does your child have in the family?
0

1

2

3

4

5

>5
0

How is the relationship between you and your child?
Unsatisfactory

Poor

Fair

Good

Excellent
0

How is/are the relationship(s) between your child and their sibling(s)?
Unsatisfactory

Poor

Fair

Good

Excellent
0

Does anyone outside your nuclear family live with you and your child(ren)?
Yes

No
0

Please elaborate
0

Does a helper/maid assist with household chores?
Yes

No
0

Has the helper/maid been heavily involved in the care of your children during their childhood?

0 / 5000
0

How well does your child respond to discipline from you in your household?
Not well at all

Poorly

Fairly well

Very well

Extremely well
0

Elaborate on your household's disciplinary methods.