MBK's 24/7 DAD Fatherhood Survey
All referral candidates are required to complete this survey as both at the beginning and end of the course. It is mandatory for enrollment and completion of the MBK Fatherhood Program, there will be no exceptions!
* Required
Email address
*
Your email
Date
*
MM
/
DD
/
YYYY
Name of Participant
*
Your answer
Pre or Post
*
Pre Test
Post Test
1. What is your birthdate?
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MM
/
DD
/
YYYY
2. Are you a father?
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Yes
No
3. What is your marital status?
*
Single
Married
Divorced
Separated
Widower
4. What is your ethnicity?
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African American
White
Hispanic/Latino
Asian
Native American
Other:
5. What's the highest grade you completed in School?
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High school
College - not completed
College - Bachelors
College - Masters
Other:
6. Have you attended a training school?
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No
Yes
Yes, vocational
Yes, business
Yes, other
7. Are you employed?
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Yes
No
8. 24/7 Dad has which of the five following traits:
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Self-awareness, physical strength, mental strength, parenting skills, & relationship skills
Self-awareness, physical strength, caring for self, fathering skills, & relationship skills
Self-awareness, caring for self, parenting skills, fathering skills & relationship skills
Caring for self, physical strength, mental strength, relationship skills & money skills
I'm not sure
9. When a 24/7 Dad uses his fathering skills, he knows:
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His children's interests & activities
His children should go to college
The unique gifts that he and their mom bring to raising their children
His children need a good relationship with their grandparents
E and D
A and C
10. Today's culture does not link body image and what it means to be a man.
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True
False
Not sure
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