• Kinship Caregiver Demographics Adult

    This form includes demographic information regarding the CAREGIVER.
  • 1. What is the time point of the survey?
  •  - -
  • 6. How was the survey completed?
  • 7. Which gender do you indentify with? If Other please specify.

  • Primary Caregiver
  • Secondary Caregiver
  • 8. What ethnicity do you identify with? (check all that apply)

  • Primary Caregiver
  • Secondary Caregiver
  • 9. What race do you identify with?

  • Primary Caregiver
  • Secondary Caregiver
  • 10. Tribal Enrollment Status (Tribal Specific)
  • 11. What is your relationship status? (select one option)

  • Primary Caregiver
  • Secondary Caregiver
  • 13. Family Housing: Please identify your housing situation (select one)
  • 14.Select the highest level of education you have completed: (select one)

  • Primary Caregiver
  • Secondary Caregiver
  • 15. What is your employment status Primary Caregiver.
  • What is your employment status Secondary Caregiver
  • What is your employment status Other Household Member
  • 16. Have you or your spouse/partner/other household member needed to cut back on your job hours worked due to kinship children’s needs?

  • Primary Caregiver
  • Secondary Caregiver
  • 17. If you or your spouse/partner/other household member are employed: is your ability to provide kinship care affecting your employment status?

  • Primary Caregiver
  • Secondary Caregiver
  • Select your total monthly household income. (select one)
  • Caregiver Health

    19. In thinking about your own health, which resources are you interested in learning about? (check all that apply) 

  • Primary Caregiver
  • Secondary Caregiver
  • 20. In general, would you say your overall health is

  • Primary Caregiver
  • Secondary Caregiver
  • Do you have any unmet healthcare needs

  • Primary Caregiver
  • Secondary Caregiver
  • Should be Empty: