A National Call to Single Moms: Please Help Us
There are some error(s). Please see each marked section below.
Required Question(s)
1.
What is your employment status?
I am a Homemaker
I am a Homemaker
I am Unemployed
I am Unemployed
I am Self-Employed, please specify type of business in comments
I am Self-Employed, please specify type of business in comments
I am Employed
I am Employed
Other
Comment:
500
characters left.
2.
What is your annual income?
Less than $20,000
Less than $20,000
$21-$50,000
$21-$50,000
$51-$99,000
$51-$99,000
Above $100,000
Above $100,000
3.
What is your level of education?
GED/High School Diploma
GED/High School Diploma
Associate Degree
Associate Degree
Bachelor's Degree
Bachelor's Degree
Master's/Doctorate Degree
Master's/Doctorate Degree
4.
What is your ethnicity?
African American
African American
Asian American
Asian American
Caucasian
Caucasian
Hispanic
Hispanic
Indian American
Indian American
Other, please specify in comments area
Other, please specify in comments area
Comment:
500
characters left.
5.
Please select your age range.
14-19 years old
14-19 years old
20-25 years old
20-25 years old
26-30 years old
26-30 years old
31-35 years old
31-35 years old
36-40 years old
36-40 years old
41-45 years old
41-45 years old
46-50 years old
46-50 years old
+50 years old
+50 years old
6.
How many children under age 18 years old?
1 Child
1 Child
2 Children
2 Children
3 Children
3 Children
4 Children
4 Children
5 or more Children
5 or more Children
Comment:
500
characters left.
7.
How long have you been a single mom?
Less than 1 year
Less than 1 year
1-5 years
1-5 years
6-10 years
6-10 years
11-15 years
11-15 years
+15 years
+15 years
8.
Do you have medical insurance?
Yes
Yes
No
No
9.
Do you have life insurance?
Yes
Yes
No
No
10.
Are your children insured?
Yes
Yes
No
No
11.
Do you currently receive child support?
Yes
Yes
No
No
12.
What are your needs today?
Financial
Financial
Parent Support
Parent Support
Health & Wellness
Health & Wellness
Education
Education
Spiritual
Spiritual
Transportation
Transportation
Relationship
Relationship
Housing
Housing
Employment
Employment
Medical
Medical
Other
13.
What forms of entertainment do you participate in?
Concerts
Concerts
Theatre
Theatre
Sports
Sports
Movies
Movies
Dancing
Dancing
Dinner
Dinner
All
All
Other
14.
How often do you take ME time?
Daily
Daily
Weekly
Weekly
Monthly
Monthly
Rarely
Rarely
15.
How often do you travel out of state?
More than 2x each year
More than 2x each year
1x each year
1x each year
Rarely
Rarely
Never
Never
16.
Would you pay a membership fee to join Project Single Moms or My Daughter's Keeper?
Yes
Yes
No
No
17.
What Annual Membership Fee would you be willing to pay?
$35
$35
$45
$45
$50
$50
18.
Would you be interested in being a contributing writer for MDK's e-magazine?
Yes
Yes
No
No
19.
Would you be interested in attending a National Conference for Mothers & Daughters?
Yes
Yes
No
No
20.
Would you travel with your daughter(s)?
Yes
Yes
No
No
Not Applicable
Not Applicable
2.