Survey

1. Please select your gender
 Male Female

2. Please select your age group
 10-19 20-39 40-59 60+

3. Please select your marital status
 Single/Never Married Single/Divorced Married Married/Previously Divorced

4. Did you grow up with your birth father in the home?
 Yes No Sometime

Please explain your Sometimes response here:

5. In what ways has your father, or the absence of a father, impacted you?

6. Did you have any other father-like influences? If so, please explain:

7. Are your children growing up, or did they grow up, with their birth father in the home?
 Yes No Sometimes I don't have children

Please explain your Sometimes response here:

8. What are some ways you believe the issue of fatherlessness can be impacted in a positive way?

9. In your opinion, what factors are contributing to or causing the rise of fatherlessness in America?

10. How would you define the term "fatherless?"

11. Leave contact information here if you wouldn't mind potentially being contacted for further dialog concerning fatherlessness. Your name and email address will do! This information is not published and will not be made public. Thanks for your willingness to help.

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