WeFam Father's Initiative Survey

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Please enter your email address in order to begin the survey.* This field is required.
example@example.com
Confirm Email
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1. What is your name?* This field is required.
First Name
Last Name
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2. What is your age?* This field is required.
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3. What is your gender?* This field is required.
Male
Female
Wish not to answer
Other
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4. What is your ethnicity?* This field is required.
Black, Non-Hispanic
White, Caucasian
Latin, Hispanic
Indian, Non-Hispanic
Asian American, Non-Hispanic
Other
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5. What is your Zip code?* This field is required.
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6. What county do you live in?
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7. What is your current marital status?* This field is required.
Single
Married
Divorced
Separated
Never Married
Widowed
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8. How old is/are your child(ren)?* This field is required.
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9. What goal(s) would you like to achieve in the WeFam Father's Initiative program?* This field is required.
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10. How important are your goal(s) to you?* This field is required.(Rate 1-10)
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11. Have you tried to meet your goal(s) before your interest in the WeFam Father's Initiative program?* This field is required.
YESNO
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12. What efforts have you made toward your goal that were effective?* This field is required.
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13. What efforts have you made toward your goal(s) that were ineffective?* This field is required.
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14. What things, in your fatherhood journey, trigger you in a negative way?* This field is required.(Whether in daily life OR with the guardian of your child)
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15. What things, in your fatherhood journey, have a positive impact to you?* This field is required.
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16. What is the biggest challenge for you as a Father?* This field is required.
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17. What type of support would like to see from the WeFam Father's Initiative program?* This field is required.(i.e. legal, financial advice, counseling, spiritual, etc.)
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18. Do you have reliable transportation?* This field is required.
YESNO
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19. What is your current job status?* This field is required.
Employed
Searching
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20. Do you know another Father who could benefit from WeFam Father's Initiative program?* This field is required.
YESNO
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21. Would you consent to WeFam taking your photo for this program for professional purposes?* This field is required.
YESNO
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22. How are communications between you and your child(ren)'s Mother?* This field is required.
Needs improvement
Poor
Well
Nonexistent
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23. Do you think new partners should be introduced if you OR the Mother/Guardian come into separate relationships?* This field is required.
YESNO
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24. Do you openly accept the possibility that the Mother/Guardian of your child(ren) may have a new partner?* This field is required.
YESNO
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25. Are you still in a relationship with your child(ren)'s Mother/Guardian?* This field is required.
YESNO
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26. How often do you spend time with your child(ren)?* This field is required.
Often (3 or more times per week)
Sometimes (Once per week)
Every now and then
Always
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27. Do you like sports?* This field is required.
YESNO
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28. Have you considered coaching as a relationship builder, or creating a hobby with your child(ren)?* This field is required.
YESNO
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29. Would you consider working with youth as a sports coach?* This field is required.
YESNO
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30. Growing up, which of these would best describe the level of interactivity between you and your father?* This field is required.
Active
Somewhat active
Lived with you at home
Inactive
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31. Do you need a legal custody agreement?* This field is required.
YESNO
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32. Would you like to seek changes in your current custody agreement?* This field is required.
YESNO
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33. Do you have a felony?* This field is required.
YESNO
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34. If discussed with our mentoring attorneys, are you willing to initiate new legal proceedings?* This field is required.
YESNO
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35. Do you already have professional representation on the case (i.e. Lawyer, Financial Advisor, Counselor, etc.)?* This field is required.
YESNO
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36. Who do you admire the most in life?* This field is required.
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37. If you could deliver one lesson in life, what would it be?* This field is required.
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38. Please take this time to provide us with your own explanation or any additional information you like for us know before you submit your survey for approval.
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Please rate this survey with 1 being the Worst, and 5 being the Best.
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