Fatherhood
Intentional Dad - Emotional Intelligence Pre-Screening
Date
*
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Month
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Day
Year
Enter Today's Date
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
What is your age?
*
What is your marital status? (choose one)
Married
Single
Separated
Divorced
Widower
What is your race? (choose one)
White
Black
Hispanic/Latino
Asian
Native American
Other
Have you ever been a part of a men's circle? (Church, School, etc.)
Yes
No
What does "emotional intelligence" mean to you?
There is no right or wrong answer.
I know how to be emotionally available for my children and family. (choose one)
Strongly Agree
Agree
I'm not sure
Disagree
Strongly Agree
I think a good way for men to handle their feelings is (choose one):
Keep them inside
Ignore them
Release them through a good workout
Talk about them with someone
All of the above
I'm not sure
I believe that having a living will and life insurance is (choose one):
Important for my family
Something that I don't understand
Not anything I need to be concerned about.
Something I have never thought about
Grieving is (choose one):
a. A way to deal with loss
b. Something that takes time, sometimes years
c. More important for women than men
dThe same thing as loss
e. a and b
I'm not sure
I feel as if I am continuing past traumas with my family (choose one):
Strongly Agree
Agree
I'm not sure what this means
Disagree
Strongly Disagree
I currently have a self-care routine that works for me (choose one):
Strongly Agree
Agree
I'm not sure
Disagree
Strongly Disagree
My current self-care routine includes (check all that apply):
I don't have a self-care routine
Working out / Gym
Sports
Prayer / Church
Drinking / Bar
Socializing with Friends
Walking / Running
Cannabis / CBD
Time with family
Other
What is the best definition of self-worth? (choose one)
The thoughts we have about ourselves
How other people value us
The overall value we have for ourselves
None of the above
The feeling we have about ourselves
What do you seek to learn from this program
Submit
Should be Empty: