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2013
October
W
Women Facing Forward - Fiver
Women Facing Forward - Fiver
Women Facing Forward Population Assessment
0%
Exit Survey
Women Facing Forward is a newly formed non-profit organization committed to empower single working mothers in transition to move beyond set backs and create a thriving future for themselves and their children. Our goal is to restore the stability of the family by providing emergency, supportive and educational services.
*****This survey should be completed by Working Single Parents*****
Please take this short 15 question survey. We want to ensure that we meet the needs of our unique population. The completion of this questionnaire will help us gauge if we are on the right track. Your survey is confidential and will be solely used to analyze data for programs offered by Women Facing Forward. It will take approximately 2-3 minutes to complete the questionnaire.
Thank you very much for your time and support. Please start with the survey now by clicking on the Continue button below.
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Zip Code:
*
What is your parenting status?
Single Mother
Single Father
Other
*
Select the applicable statement:
I am a single parent receiving some form of governmental assistance
I am a single parent who does not qualify for any form of governmental assistance
Other
Did you experience any of the following within the last year (select all that apply)?
Returned to the workforce
Unemployed
Divorced
Widowed
Career change
Relocation
Decreased wages
None
Were you late paying utility payments?
Yes
No
Other
Were you late paying rent/mortgage payments?
Yes
No
Other
Did you request assistance from one of the following (select all the apply)?
Family
Church
Community agency
Friend
Other
Did you qualify for assistance from the church?
Yes
No
Did you qualify for assistance from the community agency?
Yes
No
What was the reason for disqualification?
Over income
Other
Are you currently late on any bills?
Yes
No
Other
Do you need help budgeting household finances?
Yes
No
Other
How interested are you in learning image techniques (wardrobe, make-up, hair)?
Very interested
Slightly interested
Undecided
Not interested
Other
Are you interested in career guidance?
Very interested
Slightly interested
Undecided
Not interested
Other
Do you need guidance in the following areas?
Strong Need
Moderate Need
Undecided
No
Managing Stress
Life Balance
Personal Growth
What type of assistance would benefit you the most: (Select all that apply)?
Utilities
Food
Car Repair/Cota Passes
Housing Assistance
Clothing Child Care
Other
Please provide additional comments/suggestions here:
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