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Questions marked with an * are required Exit Survey
 
 
1. Hello:
You are invited to participate in our survey about minors in a hostile home enviroment. In this survey, approximately 150 people will be asked to complete a survey that asks questions about home life. It will take approximately 10 minutes to complete the questionnaire.

Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point. It is very important for us to learn your opinions.

Your survey responses will be strictly confidential and data from this research will be reported only in the aggregate. Your information will be coded and will remain confidential.

Thank you very much for your time and support. Please start with the survey now by clicking on the Continue button below.
 
 
 
* 2. Who do you live with? (Select all that apply)
 
Mother
 
Father
 
Aunt
 
Uncle
 
Grandmother
 
Grandfather
 
Legal Guardian

 
 
3. Select the best fit for you.
Very Unsatisfied Unsatisfied Neutral Satisfied Very Satisfied N/A
* Home Life
* Guidance from parent/guardian
* Learning
* After school help
 
 
 
4. At this time we need to confirm you are a real person. To continue please enter the characters in the rectangle. 
   
 
 
 
5. What was the last day that you got help from a parent or guardian?
MonthDayYear
  
 
 
 
6. When is the last time you were yelled at by a parent/guardian?
MonthDayYear
  
 
 
 
7. When was the last time you were punished by a parent or guardian?
MonthDayYear
  
 
 
 
8. What is your gender?
 
Male
 
Female
 
 
 
9. What is your marital status?
 
Single (Never married)
 
Married
 
Domestic partnership
 
Widowed
 
Divorced
 
Separated
 
Don’t know
 
 
 
10. What is your age?
 
Younger than 18
 
18 - 24
 
25 - 34
 
35 - 44
 
45 - 54
 
55 - 64
 
65 or older
 
Prefer not to answer
 
 
 
11. What is the highest level of education you have achieved?
 
Less than high school degree
 
High school degree or equivalent (e.g. GED)
 
Some college but no degree
 
Associate degree (e.g. AA, AS)
 
Bachelor's degree (e.g. BA, AB, BS)
 
Master's degree (e.g. MA, MS, MBA)
 
Professional degree (e.g. MD, DDS, JD)
 
Doctorate degree (e.g. PhD)
 
 
 
12. Which of the following categories best describes the industry you work in?
 
Automotive
 
Advertising
 
Consulting Services
 
Education
 
Entertainment
 
Financial Services
 
Government Services
 
Healthcare
 
Human Resources
 
Information Technology
 
Marketing/Sales
 
Non-Profit
 
Pharmaceuticals
 
Public Relations
 
Technical Services
 
Travel
 
Other
 
 
 
13. Please note that personal questions are used strictly for demographic and data validation.
 
 
Child Abuse Study