Adult Pro Kids Survey

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Adult Pro Kid Survey

We are Promethean Foundation, a non-profit 501c3, dedicated to learning more about educating young children. You were an important part of this research in your early years. We appreciate you being a part of this research, and we hope you will continue to keep in touch with us. We anticipate great things in your future.

* Indicates required field

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Email *

Mark All Items that Apply and Fill in the Blanks as Needed:

1. Which best describes your housing arrangement? *

I currently have no permanent address I own my home, and there is no cost for housing I am buying my home and making payments I rent my home and pay rent I live in government subsidized housing and pay rent I live in student housing I live with someone who provides a home at no cost I live with someone and we share the cost of a home

If Other please specify: *

Amount of rent/payment per month? *

2. How many people live in your household?

Adults *

Children under 18 *

3. Voting

I am registered to vote *

Yes No

I consider participation in voting important for all citizens *

Yes No

4. What is your current living arrangement? *

I am single, never married, the only adult living in my home I am single, only adult in my home, separated from my spouse I am single, only adult in my home, divorced from my spouse I am single, only adult in my home, widowed from my spouse I am single but living with a partner – not married I am single but living with family I am single but living with a friend or friends I am married and living with my spouse

Dates of Separation/Divorce/Marriage/Widowing *

6. What is your personal monthly Income? (Include all sources of personal income before taxes.) *

$0-$500 $501-$1,000 $1001-$2,000 $2,001-$3,000 $3.001-$4,000 $4,001-$5,000 $5,001-$6,000 Over $6,000 per month

7. What is the highest level of formal education you have completed?

Middle School, 8th grade

Some high school

GED or Home School/On-Line Diploma Completed

Year completed *

High School Diploma; Graduation

Year *

School *

Vocational/Technical Certificate or License

Type *

Year *

Some college credit completed

Date last attended *

College Degree completed

Type *

AS BS MS PhD

Other

8. How often do you attend religious services? (Church, Mass, etc) *

I do not attend religious services I attend religious services 1-4 times per year I attend religious services at least monthly I attend religious services weekly or more often

9. How would you describe your participation in volunteer or leadership activities? *

I am not active in volunteer/community work I participate in volunteer/community work 1-4 times per year I participate as a volunteer/community work monthly I participate as a volunteer/community work weekly or more often

10. How would you describe your relationship with people outside of your family? *

I do not have anyone I consider a friend. I sometimes feel alone. I have friends, but no one I feel close to. I do not go out with friends much. I have someone I consider a close friend. We sometimes talk and do things together. I feel like I have several friends and we go out socially at times. I feel I have many friends and a full social life.

11. Do you have children? (Check all that apply)

I have no children.

How old were you when your first child was born?

How many biological children do you have?

How many biological children are living with you?

How many stepchildren do you have living with you?

How many adopted children are living with you?

How many foster children are living with you?

12. Are you currently working and/or going to school? (Check all that apply)

Choose Any *

I am currently unemployed.

I am a full-time at-home parent with no other job.

I am employed part-time: Where do you work?

I am employed full-time: Where do you work?

I am currently a full-time student. Where:

I am currently a part-time student. Where:

I am in military service. Branch of military:

Other

14. Have you experienced any of the following? (Check all that apply)

Tobacco Use in last month:

Never Rarely Some daily Many times a day

Have you had arrests and/or convictions for a misdemeanor in the last year? Have you had arrests and/or convictions for a felony in last year? Have you served jail and/or prison time in the last year? Have you used illegal prescriptions, cocaine, heroin, or meth, etc. in the last year? Have you used marijuana in the last year? Have you been convicted of domestic violence in the last year? Have you participated in drug or alcohol treatment in the last year? None of the above Other

15. What are some of your interests? (Check all that apply) *

I enjoy quiet hobbies such as: sewing, arts/crafts, photography, or electronic gaming. I participate in active sports such as: hunting, tennis, camping, baseball, or walking. I like building/construction type activities and working on engines/equipment. I enjoy reading for pleasure. I enjoy playing an instrument, or singing with a group, choir, or band. I enjoy participating in community theater as an actor or behind the scenes. I enjoy attending concerts, plays, movies, or cultural events. Other

16. What are your goals for the next few years in the following areas?

Education *

Family *

Employment *

Housing *

Transportation *

Other *

Thank you for your cooperation in completing this survey. We would like to keep in touch.

Submit

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