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New Castle Co. March Dadness Roller Skating Edition
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20
Questions
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1
Name
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First Name
Last Name
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2
Phone Number
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Area Code
Phone Number
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3
Email
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example@example.com
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4
Age
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5
County you currently reside?
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New Castle
Kent
Sussex
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6
Income Range
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$0 - $9999
$10000 - $19999
$20000 - $29999
$30000 - $3999
$40000+
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7
Please select what best describes your race or family background:
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African American
American Indian/Alaskan Native
Caucasian
Hispanic
Asian
Other
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8
Number of Guest(s):
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9
Number of children
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10
Are you aware of the Delaware Fatherhood and Family Coalition?
YES
NO
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11
Have you ever participated in a Delaware Fatherhood and Family Coalition event including a county coalition leadership meeting?
YES
NO
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12
Are you a member of the Delaware Fatherhood and Family Coalition?
YES
NO
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13
How would you rate your level of knowledge of the Delaware Fatherhood and Family Coalition?
1
2
3
4
5
Little To Non
Very Knowledgeable
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14
How do you rate the level of importance of a father's involvement in the lives of a child(ren)?
1
2
3
4
5
Not Important
Extremely Important
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15
Are you aware of the positive effects of father involvement in a child's life?
1
2
3
4
5
Little to Non
Extremely Aware
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16
How important is effective co-parenting in child-rearing?
1
2
3
4
5
No to Non
Very Important
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17
Are you aware of the positive impact on a child's development when parents effectively co-parent?
1
2
3
4
5
Little To Non
Extremely Important
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18
How would you rate your level of awareness of the importance of effective co-parenting in the life of a child(ren)?
1
2
3
4
5
Little To Non
Very Aware
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19
Do you believe you have knowledge to speak to others about the importance of father involvement?
1
2
3
4
5
Do Not Have The Knowledge
Very Knowledgeable
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20
Do you believe you have the knowledge to speak to others about the importance of effective co-parenting?
1
2
3
4
5
Knowledgeable
Very Knowledgeable
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