A National Call to Single Moms: Please Help Us
RequiredRequired Question(s)
Required 1.
What is your employment status?
I am a Homemaker
I am Unemployed
I am Self-Employed, please specify type of business in comments
I am Employed
Other  
  • Comment:

  • 500 characters left.
Required 2.
What is your annual income?
Less than $20,000
$21-$50,000
$51-$99,000
Above $100,000
Required 3.
What is your level of education?
GED/High School Diploma
Associate Degree
Bachelor's Degree
Master's/Doctorate Degree
Required 4.
What is your ethnicity?
African American
Asian American
Caucasian
Hispanic
Indian American
Other, please specify in comments area
  • Comment:

  • 500 characters left.
Required 5.
Please select your age range.
14-19 years old
20-25 years old
26-30 years old
31-35 years old
36-40 years old
41-45 years old
46-50 years old
+50 years old
Required 6.
How many children under age 18 years old?
1 Child
2 Children
3 Children
4 Children
5 or more Children
  • Comment:

  • 500 characters left.
Required 7.
How long have you been a single mom?
Less than 1 year
1-5 years
6-10 years
11-15 years
+15 years
Required 8.
Do you have medical insurance?
Yes
No
Required 9.
Do you have life insurance?
Yes
No
Required 10.
Are your children insured?
Yes
No
Required 11.
Do you currently receive child support?
Yes
No
Required 12.
What are your needs today?
Financial
Parent Support
Health & Wellness
Education
Spiritual
Transportation
Relationship
Housing
Employment
Medical
Other  
Required 13.
What forms of entertainment do you participate in?
Concerts
Theatre
Sports
Movies
Dancing
Dinner
All
Other  
Required 14.
How often do you take ME time?
Daily
Weekly
Monthly
Rarely
Required 15.
How often do you travel out of state?
More than 2x each year
1x each year
Rarely
Never
Required 16.
Would you pay a membership fee to join Project Single Moms or My Daughter's Keeper?
Yes
No
Required 17.
What Annual Membership Fee would you be willing to pay?
$35
$45
$50
Required 18.
Would you be interested in being a contributing writer for MDK's e-magazine?
Yes
No
Required 19.
Would you be interested in attending a National Conference for Mothers & Daughters?
Yes
No
Required 20.
Would you travel with your daughter(s)?
Yes
No
Not Applicable