Today's Family Experience Survey Thanks for taking a few minutes to help us know you better and focus on content that helps you connect with your family. If you have ideas or suggestions that are hard to capture on a this survey please don't hesitate to call me at 360-690-8495 or email me at chagele@projectpathc.org.Thanks for your help.Chuck Question Title * 1. Feel free to share as much information about yourslef as you feel comfortable. We will protect your information. Name: Address: Address 2: City/Town: State: -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: Email Address: Phone Number: Question Title * 2. What role brings you to our content? Parent Grandparent Mentor Teacher Therapist Pastor Other (please specify) Question Title * 3. What ages are the kids in your life? 0-2 3-5 6-8 9-12 13-15 16-18 19-22 23+ Question Title * 4. What topics are you most interested in hearing more about? 5 Very Interested 4 3 Neutral 2 1 Least Interested NA Discipline Discipline 5 Very Interested Discipline 4 Discipline 3 Neutral Discipline 2 Discipline 1 Least Interested Discipline NA Values Values 5 Very Interested Values 4 Values 3 Neutral Values 2 Values 1 Least Interested Values NA Technology - Internet Technology - Internet 5 Very Interested Technology - Internet 4 Technology - Internet 3 Neutral Technology - Internet 2 Technology - Internet 1 Least Interested Technology - Internet NA Technology - Video Games Technology - Video Games 5 Very Interested Technology - Video Games 4 Technology - Video Games 3 Neutral Technology - Video Games 2 Technology - Video Games 1 Least Interested Technology - Video Games NA Technology - Social Media Technology - Social Media 5 Very Interested Technology - Social Media 4 Technology - Social Media 3 Neutral Technology - Social Media 2 Technology - Social Media 1 Least Interested Technology - Social Media NA Dating Dating 5 Very Interested Dating 4 Dating 3 Neutral Dating 2 Dating 1 Least Interested Dating NA Passing on faith Passing on faith 5 Very Interested Passing on faith 4 Passing on faith 3 Neutral Passing on faith 2 Passing on faith 1 Least Interested Passing on faith NA Mentoring Mentoring 5 Very Interested Mentoring 4 Mentoring 3 Neutral Mentoring 2 Mentoring 1 Least Interested Mentoring NA Kid's Friends Kid's Friends 5 Very Interested Kid's Friends 4 Kid's Friends 3 Neutral Kid's Friends 2 Kid's Friends 1 Least Interested Kid's Friends NA Bullying Bullying 5 Very Interested Bullying 4 Bullying 3 Neutral Bullying 2 Bullying 1 Least Interested Bullying NA Teaching good habits Teaching good habits 5 Very Interested Teaching good habits 4 Teaching good habits 3 Neutral Teaching good habits 2 Teaching good habits 1 Least Interested Teaching good habits NA Question Title * 5. How familiar are you with programs offered by Project Patch? 5 Very Familiar 4 3 Neutral 2 1 Not Familiar NA Youth Ranch for struggling teens Youth Ranch for struggling teens 5 Very Familiar Youth Ranch for struggling teens 4 Youth Ranch for struggling teens 3 Neutral Youth Ranch for struggling teens 2 Youth Ranch for struggling teens 1 Not Familiar Youth Ranch for struggling teens NA Family Experience Family Experience 5 Very Familiar Family Experience 4 Family Experience 3 Neutral Family Experience 2 Family Experience 1 Not Familiar Family Experience NA Seminars/Speaking Seminars/Speaking 5 Very Familiar Seminars/Speaking 4 Seminars/Speaking 3 Neutral Seminars/Speaking 2 Seminars/Speaking 1 Not Familiar Seminars/Speaking NA Question Title * 6. What would you like to see us doing more of? Question Title * 7. Any other suggestions? Question Title * 8. Would you liked to be contacted to discuss this survey? Yes No If yes, what is the best method for contacting you? Done