Request edit access
JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Project Matriarchs: Parent Interest Form
Hi there!
Thank you for your interest in Project Matriarchs and our virtual support. We know that many of you are in extremely overwhelming situations during this pandemic and we look forward to supporting you as best we can in a virtual format.
Sign in to Google
to save your progress.
Learn more
* Required
Email
*
Your email
Name
Your answer
Best email address
Your answer
Phone Number
Your answer
How did you learn about Project Matriarchs?
Your answer
With what ethnicities do you identify (check all that apply)? This information will help us understand the demographic breakdown of the families we’re working with, and help us identify if we’re reaching our goals of equity and inclusion.
Asian
Black/African
White
Hispanic/Latinx
Native American
Pacific Islander
Prefer not to answer
Other:
What time zone are you in?
PT
MT
CT
ET
Other:
Clear selection
How many children would you like this service for?
Your answer
If you want this service for multiple children, would you like them each to be matched with someone separately or just have your family matched with one college student?
One college student matched with one child
One college student matched with multiple children
Clear selection
How old is/are your child(ren)?
Your answer
Approximately how many hours per week (per child, if applicable) would you like support?
1
3
5
7
9
11
13
15+
Other:
Clear selection
What times throughout the week would you like support? Check all that apply.
Monday mornings
Monday afternoons
Tuesday mornings
Tuesday afternoons
Wednesday mornings
Wednesday afternoons
Thursday mornings
Thursday afternoons
Friday mornings
Friday afternoons
Saturday mornings
Saturday afternoons
Sunday mornings
Sunday afternoons
What, mainly, would you like the college student to work on with your child(ren)/how would you like them to spend their time together? Please check all that apply.
Class work/homework
enrichment content
mentorship
creative projects
Other:
Are there any subjects in particular you would like the college student(s) to focus on with your child(ren)?
Your answer
Do you have any gender preference for the college student your child will be matched with?
Male
Female
No preference
Other
Please elaborate on the preferences indicated above if you have any requests/needs in terms of gender.
Your answer
How much (per hour, per child) do you feel able to pay? We will be paying college students $15 an hour so anything above that will be used to provide our service for free or at a lower price for those that need it.
$0
$5
$10
$15
$20
$25
$30
$35
$40
$45
$50
$60
$70
Other:
Clear selection
Has your employer done anything to support you/other employees as a working parent during the pandemic?
*
yes
No
n/a
If you answered yes to the above question, please briefly describe what your employer has done to support working parents during the pandemic and how satisfied you've been with this.
Your answer
What could your employer be doing to better support working parents, particularly mothers, during the pandemic?
Your answer
Are you willing to fill out regular brief surveys (~2 mins) that will help us gauge your satisfaction, assess effectiveness, and improve our service? (We can't overstate how helpful this would be for us!)
Yes
No
Clear selection
Check out our first advocacy initiative, Pledge to Care:) Sign it and share it!
https://bit.ly/signpledgetocare
I'd like to lear how I can get involved
Clear selection
Send me a copy of my responses.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This form was created inside of Stanford University.
Report Abuse
Forms
