SCSCY Adoption Permanency Division Demographic Evaluation
RequiredRequired Question(s)
The Adoption Permanency Division Webinar are for perspective and/or adoptive parents. In order for us to make sure you are a candidate for the Parent Education Classes, please fill out the following survey and we will send you a confirmation email. Thank you!

Please complete survey
 
Required 1.
Please enter the information indicated below.

First Name:
Last Name:
Email Address:
emailaddress@xyz.com
Address 1:
Address 2:
City:
State/Province
(US/Canada):
Postal Code:

Required 2.
Which category below includes your age?
17 or younger
18-20
21-29
30-39
40-49
50-59
60 or older
Required 3.
Ethnicity
White
Black or African-American
American Indian or Alaskan Native
Asian
Native Hawaiian or other Pacific Islander
Some other race (please specify)
  • Comment:

  • 500 characters left.
Required 4.
What is your gender?
Female
Male
Other (specify)
  • Comment:

  • 500 characters left.
Required 5.

Are you now married, widowed, divorced, separated, or never married?

Married
Widowed
Divorced
Separated
Never married
Required 6.
What is the highest level of school you have completed or the highest degree you have received?
Less than high school degree
High school degree or equivalent (e.g., GED)
Some college but no degree
Associate degree
Bachelor degree
Graduate degree
Required 7.

Which one describes you? 

Parents from the general community
Adoptive Parent
Foster perspective adoptive parent
Other
  • Comment:

  • 500 characters left.
Required 8.
How many kids are in your household?
 

50 characters left.
Required 9.
How many children ages range from 0-10?
 

50 characters left.
Required 10.
How many children ages range from 11-17?
 

50 characters left.