Parent-Child Relationship Survey

Gender: Male / Female Year Born: 1925-1945 1946-1964 1965-1980 1981-2000

1. Please choose one of the following to describe your family structure Parents are married Parents are divorced

2. On a scale from 1-5 how close would you describe your relationship with your parents? 1 Not close 3. Who are you more close with? Mom _____ Dad ________ 2 3 4 5 Extremely close

4. How often do you go to your mom for advice? 1 Not often 5. How often do you go to your dad for advice? 1 Not often 2 3 4 5 All the time 2 3 4 5 All the time

6. Circle all which apply to your relationship with your mom: Best Friends Strictly mother-daughter/ son relationship Mentor No relationship Hero Other __________________

7. Circle all which apply to your relationship with your father: Best Friends Strictly Father-daughter / Son relationship 8. Who is more strict? Mom __________ Dad ___________ Mentor No relationship Hero Other __________________

9. On a scale of 1-5, how much more strict are they compared to the other parental figure? 1 2 3 4 5

Not at all

Extremely strict

10. 0n a scale if 1-5, how often were your parents home? 1 2 3 4 5

Not at all 11. How often were you disciplined? Never Sometimes Rarely

All the Time

Only when disobedient

Everyday

12. Do you have children? If no, go to question 15 Yes _________ No ___________

13. If yes, on a scale of 1-5 what is your relationship with your children? 1 2 3 4 5

Not Close

Extremely close

14. Would you consider yourself closer with your kids than you were with your own parents? Yes ________ No __________

15. If no, on a scale of 1-5, how close would you want your relationship to be if you did have children? 1 2 3 4 5

Not Close

Extremely close