Email
example@example.com
How many months have you been a member of Undivided?
What is your current employment status?
I care for my child/children full-time
Full-time employment
Part-time employment
Self-employed
Did you leave your job to care for your child full-time?
Yes
No
How many hours per month did/do you spend learning or researching how to support your child? (understanding accommodations, specialists, providers, IEP goals, etc.)
Rows
Prior to joining Undivided
Currently
Per month
0-2 hours
3-6 hours
7-10 hours
11+ hours
0-2 hours
3-6 hours
7-10 hours
11+ hours
How many times per month did/do you typically need to take unplanned time off from work to care for your child?
Rows
Prior to joining Undivided
Currently
Per month
Not at all
1-3 occurrences
4-6 occurrences
7+ occurrences
Not at all
1-3 occurrences
4-6 occurrences
7+ occurrences
Prior to leaving your job: How many times per month did you typically need to take unplanned time off from work to care for your child?
Not at all
1-3 occurrences
4-6 occurrences
7+ occurrences
How many times per month did/do you typically miss deadlines or appointments at work to accommodate your child's needs?
Rows
Prior to joining Undivided
Currently
Per month
Not at all
1-3 occurrences
4-6 occurrences
7+ occurrences
Not at all
1-3 occurrences
4-6 occurrences
7+ occurrences
Prior to leaving your job: How many times per month did you typically miss deadlines or appointments at work to accommodate your child's needs?
Not at all
1-3 occurrences
4-6 occurrences
7+ occurrences
How many days per month was/is it difficult to focus on anything but your child?
Rows
Prior to joining Undivided
Currently
Per month
A few days
About half
More than half
Almost every day
A few days
About half
More than half
Almost every day
Prior to leaving your job: How many days per month was it difficult to focus on anything but your child?
A few days
About half
More than half
Almost every day
How many days per month do you feel overwhelmed?
Rows
Prior to joining Undivided
Currently
Per month
A few days
About half
More than half
Almost every day
A few days
About half
More than half
Almost every day
How many days per month do you feel exhausted at work?
Rows
Prior to joining Undivided
Currently
Per month
A few days
About half
More than half
Almost every day
A few days
About half
More than half
Almost every day
Prior to leaving your job: How many days per month did you feel exhausted at work?
A few days
About half
More than half
Almost every day
Has your employer been supportive of your family's needs when caring for your child?
Rows
Prior to joining Undivided
Currently
Support level
Very supportive
Somewhat supportive
Not supportive
Unaware of my family's needs
Very supportive
Somewhat supportive
Not supportive
Unaware of my family's needs
Prior to leaving your job: Was your employer supportive of your family's needs when caring for your child?
Very supportive
Somewhat supportive
Not supportive
Unaware of my family's needs
Do you feel comfortable talking to your employer about your child’s disability?
Rows
Prior to joining Undivided
Currently
Comfort level
Completely
Somewhat
Not at all
Completely
Somewhat
Not at all
Prior to leaving your job: Did you feel comfortable talking to your employer about your child’s disability?
Completely
Somewhat
Not at all
When you left your job: Did you discuss the reason for leaving with a member of the HR team?
Completely
Somewhat
Not at all
How would you feel about your employer / previous employer if they provided Undivided Membership to help support your family?
Have you ever considered leaving your job to care for your child full-time?
Yes
No
Would you feel comfortable recommending Undivided to your employer / previous employer?
Submit
Should be Empty: