• www.itsfatherhood.org

  • I.T.S. Fatherhood Impact Survey

  • Consent & Participant Information

  • Do you consent to participate in this survey and allow your de-identified responses to be used for research?*
  • Pronouns
  • Date of Birth*
     - -
  • Format: (000) 000-0000.

  • Demographic Information

  • Primary Language
  • Veteran Status
  • Number of children in household*

  • Fatherhood Identity & Family Structure

  • Type of Relationship to Child*
  • Are you currently providing financial support for your child(ren)?*
  • How often do you spend time with or visit your child(ren)?
  • Rows

  • Employment & Financial Stability

  • Health & Mental Well-Being

  • How would you rate your current physical health?*
  • Any ongoing medical conditions you are managing?
  • How often have you felt overwhelmed or stressed in the past month?*
  • Do you have someone or a support system you can talk to when stressed?*

  • Barriers & Need Assessment

  • What challenges make it hard to attend programs regularly? (Select all that apply)*
  • What programs or services are you interested in? (Select all that apply)*

  • Program Expectations & Goals

  • What are you hoping to improve or achieve as a father through this program?*
  • How motivated are you to make positive changes for your family?
  • Are you open to meeting with a coach or mentor for additional support?*
  • Which program format would help you participate more consistently?*
  • What days are easiest for you to attend sessions?*
  • What time of day works best for you?*

  • Consent & Permissions

  • I understand that participation in I.T.S programs is voluntary.*
  • I understand that I.T.S may collect my survey responses to improve programs and support services.*
  • I understand that my personal information will be kept confidential and stored securely.*
  • I agree to receive SMS updates (up to 4–6 messages per month) sent via an autodialer from I.T.S. Fatherhood. This agreement isn't a condition of any purchase. Message and data rates may apply. Reply STOP to unsubscribe at any time. We don't sell your information, and SMS opt-in data will not be shared for marketing purposes. Questions: info@itsfatherhood.org*
  • I give permission to receive email communication about updates and reminders.*

  • You have chosen not to provide consent. Submitting now will complete the survey without your responses. 


    Do you want to proceed with submission, or go back to change your choice?

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