Instrument 9: Demographic questionnaire-coparents

CHaRMED BRIEF QUESTIONNAIRE

COPARENTS FOCUS GROUP

As our last activity, we wanted to get some basic information about you and your relationships. You can skip any questions you don’t want to answer, and your name will not be associated with your answers. These questions should take you no more than 15 minutes to complete. [HAND OUT QUESTIONNAIRE]

1. How old are you? Check only one (Source: Fatherhood and Marriage Local Evaluation and Cross-Site Data Collection study)¹

• 18-20 years

• 21-24 years

• 25-34 years

• 35-44 years

• 45-54 years

• 55-64 years

• 65 years or older

2. What is your race? Mark all that apply (Source: Census/Fatherhood and Marriage Local Evaluation and Cross-Site Data Collection study)

• American Indian or Alaska Native

• Asian

• Black or African American

• Native Hawaiian or Other Pacific Islander

• White or Caucasian

• Other (please specify ______________________)

3. What is your ethnicity? Check only one (Source: Census/Fatherhood and Marriage Local Evaluation and Cross-Site Data Collection study)

• Hispanic or Latino

• Not Hispanic or Latino

4. What is the highest level of education you have completed? Check only one (Source: Fatherhood and Marriage Local Evaluation and Cross-Site Data Collection study with adaptations)

□ No high school degree or diploma earned

□ High school General Education Development/GED or High school Equivalency Test/HSE

□ High school diploma

□ Vocational/technical certification

□ Some college but no degree or diploma earned

□ Associate or two-year college degree

□ Bachelor’s or four-year college degree or higher

5. Which of the following categories best describes your employment status? Check only one (Source: Fatherhood and Marriage Local Evaluation and Cross-Site Data Collection study)

• Full-time employed (usually work 35 or more hours a week)

• Part-time employed (usually work 1-34 hours a week)

• Employed but number of hours changes from week to week

• Not currently employed, but actively looking for work

• Not currently employed, and not looking for work

6. Which of the following describes your relationship to the father we’ve been discussing today that participates in [FATHERHOOD PROGRAM]? Check only one (New question)

• We are romantically involved and share a biological or adopted child

• We are romantically involved but do not share a biological or adopted child

• We share a biological or adopted child but are not currently romantically involved

• I’m related to him (mother, sister, cousin, aunt, etc.)

• Other (please specify ____________)

7. What is your current relationship status? Please respond thinking about your current romantic partner (if any), whether or not they are the father we've been talking about. Check only one that best applies (New question)

• Not in a relationship

• Married

• Living with a partner all or most of the time, but not married (cohabiting)

• In a relationship, but not married or cohabiting

1 OMB control number: 0970-0460. These items come from the applicant characteristics survey found here: https://www.famlecross-site.com/nForm/Content/ACS.pdf.