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$20,000-$44,000
$45,000-$60,000
$61,000-$80,000
$81,000 and up
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Race
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How many children do you have? (Count Adult Children)
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1st Child Age
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2nd Child Age
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3rd Child Age
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4th Child Age
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5th Child Age
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Write the Age of each additional child. Separate with comma
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Number of Male children
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Number of Female Children
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How many of your children are under the age of 8?
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Highest level of education?
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Engagement
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Religious Affiliations (optional disclosure - all are welcome)
Have you ever participated in organized sports?
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If yes to sports, how long?
What do you hope to gain from these meetings? Click all that apply
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Community
Leadership Skills
Networking
Financial Support (Basic Needs)
Legal Help
Supervised Visits
Parenting Skills
Fatherhood Resources
Counseling Referral
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Are you in court?
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Do you have an attorney?
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Are you seeking assistance?
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Are you on supervised visits?
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Is there a protective order in place?
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Have allegations been made against you?
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Are there any accusations for you against a child?
Are there protective orders in place? If yes, what is the charge?
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Are there any accusations for you against a child?
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