Your Sex Male Female

Race/Ethnicity Native American or Alaskan Native Asian African American African Nationals/Caribbean Islanders Hispanic or Latino Middle Eastern Native Hawaiian/Pacific Islanders White (Non Hispanic/European American) Multi-racial

Marital Status: Married Partnered Single Divorced Widowed Separated

Family Housing Own Rent Shared housing with relatives/friends Temporary (shelter, temporary with friends/relatives) Homeless

Family Income $0-$10,000 $10,001-$20,000 $20,001-$30,000 $30,001-$40,000 $40,001-$50,000 more than $50,001

Highest Level of Education Elementary or junior high school Some high school High school diploma or GED Trade/Vocational Training Some college 2-year college degree (Associate’s) 4-year college degree (Bachelor’s) Master’s degree PhD or other advanced degree

Sex of 1st child Male Female

Your Relationship to child Birth parent Adoptive parent Grand/Great Grandparent Sibling Other relative Foster-parent other

Sex of 2nd child Male Female

Your Relationship to child Birth parent Adoptive parent Grand/Great Grandparent Sibling Other relative Foster-parent other

Sex of 3rd child Male Female

Your Relationship to child Birth parent Adoptive parent Grand/Great Grandparent Sibling Other relative Foster-parent other

Sex of 4th child Male Female

Your Relationship to child Birth parent Adoptive parent Grand/Great Grandparent Sibling Other relative Foster-parent other

Never

Very Rarely

Rarely

About Half the Time

Frequently

Very Frequently

Always

In my family, we talk about problems.

When we argue, my family listens to "both sides of the story."

In my family, we take time to listen to each other.

My family pulls together when things are stressful

My family is able to solve our problems.

I praise my child when he/she behaves well.

When I discipline my child, I lose control.

I am happy being with my child.

My child and I are very close to each other.

I am able to soothe my child when he/she is upset.

I spend time with my child doing what he/she likes to do.

Strongly Disagree

Mostly Disagree

Slighty Disagree

Neutral

Slighty Agree

Mostly Agree

Strongly Agree

I have others who will listen when I need to talk about my problems.

When I am lonely, there are several people I can talk to.

I would have no idea where to turn if my family needed food
or housing.

I wouldn’t know where to go for help if I had trouble making ends meet.

If there is a crisis, I have others I can talk to.

If I needed help finding a job, I wouldn’t know where to go for help.

There are many times when I don’t know what to do as a parent.

I know how to help my child learn.

My child misbehaves just to upset me.