Part 1
Part 2
Part 3
Part 4
Part 5
Part 6
Part 7
Part 8
Birth2Work and Parent Friends Functional Family Survey (Part 1 of 8)
Please fill in a value for all fields:
1. What is your age?
16-18
19-22
23-29
30-35
35-40
40-50
50-60
60+
2. What is your gender?
Male
Female
3. Is your spouse/partner taking this survey?
Yes
Not Applicable
No
4. What is your current zip code?
5. What is your Ethnicity?
White
Asian or Pacific Islander
Hispanic or Latino
American Indian or Alaskan Native
Black
Two or More Races
6. What is your Level of Education?
Some High School
College Graduate
High School Graduate
Masters Graduate
Trade School / Tradesman
PHD / Doctorate
Some College
7. Did you live in the same home from the time you were born to age 10?
Yes
No
8. If yes to question 7, were you in an urban or rural community?
I did NOT live in the same home from birth to age 10
Urban
Suburban
Rural
Don't know
9. If no to question 7, how many times did you move in that 10 year time period?
0
1
2
3
4
5
6
More than 6 times
Don’t know
10. How many children do you have or do you take care of in your home?
0
1
2
3
4
5
More than 5
11. What are the specific ages of each child living in your home (mark all that apply)?
Not Applicable
3-5
11-13
18-22
0-1
5-8
14-16
Over 22
1-3
8-11
16-18
12. Have you ever taken a parent training or early childhood (human) development course?
Yes
No
13. Do you trust your own instincts for raising (your) children?
Yes
Not Applicable
No
14. Do you feel that pro-active parent training and current information on brain development might help you/others be more successful in raising children?
Yes
No
Don't Know