Caring for a Motherless Daughter

The Motherless Daughters Ministry has been serving motherless daughters internationally for over 20 years. Some have deceased mothers. Some have living mothers. These women have many different and many similar stories. Some have lost a mother through death, some have experienced emotional absence, some have experienced mothers who have (had) narcissistic characteristics. All are motherless daughters.

We recognize there are many individuals like you who are responsible for motherless daughters and have become their caretakers. Sometimes it was a choice. Sometimes it was the only thing you could do. Regardless of your circumstances, you are giving your love and attention. Our hope is to create a support group for you and others who share similar burdens.

Our question is who takes care of you?

Thanks for your time and thoughts,

Pat Kuykendoll, Holistic Empowerment Leader

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* 1. Please check which age applies to you as the person in the role of caretaker.

under 20

20-30

31-40

41-50

51-60

61-70

71-80

81 and over

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* 2. Please check which applies.

Single

Married

Divorced

Separated

Widow

Other (please specify)

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* 3. Which do you identify with?

American Indian or Alaska Native

Asian

African American

Hispanic or Latino

Native Hawaiian or other Pacific Islander

White

Prefer not to answer

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* 4. Are you employed outside the home?

Yes

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* 5. At what age did you begin your role as caretaker to the motherless daughter(s)?

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* 6. Please check the number of adults other than you living in the home and their ages.

	1	2	3	4	5 or more
under 20	under 20 1	under 20 2	under 20 3	under 20 4	under 20 5 or more
21-30	21-30 1	21-30 2	21-30 3	21-30 4	21-30 5 or more
31-40	31-40 1	31-40 2	31-40 3	31-40 4	31-40 5 or more
41-50	41-50 1	41-50 2	41-50 3	41-50 4	41-50 5 or more
51-60	51-60 1	51-60 2	51-60 3	51-60 4	51-60 5 or more
61-70	61-70 1	61-70 2	61-70 3	61-70 4	61-70 5 or more
71-80	71-80 1	71-80 2	71-80 3	71-80 4	71-80 5 or more
81 and over	81 and over 1	81 and over 2	81 and over 3	81 and over 4	81 and over 5 or more

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* 7. Please check the number of children living in the home and their ages.

	1	2	3	4	5 or more
Under 1 year	Under 1 year 1	Under 1 year 2	Under 1 year 3	Under 1 year 4	Under 1 year 5 or more
2-4 years	2-4 years 1	2-4 years 2	2-4 years 3	2-4 years 4	2-4 years 5 or more
5-6 years	5-6 years 1	5-6 years 2	5-6 years 3	5-6 years 4	5-6 years 5 or more
7-10 years	7-10 years 1	7-10 years 2	7-10 years 3	7-10 years 4	7-10 years 5 or more
11-13 years	11-13 years 1	11-13 years 2	11-13 years 3	11-13 years 4	11-13 years 5 or more
14-16 years	14-16 years 1	14-16 years 2	14-16 years 3	14-16 years 4	14-16 years 5 or more
17-18 years	17-18 years 1	17-18 years 2	17-18 years 3	17-18 years 4	17-18 years 5 or more

Other (please specify)

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* 8. Please check the age of the motherless daughters you care for.

	1	2	3	4	5 or more
Under 1	Under 1 1	Under 1 2	Under 1 3	Under 1 4	Under 1 5 or more
2-4	2-4 1	2-4 2	2-4 3	2-4 4	2-4 5 or more
5-6	5-6 1	5-6 2	5-6 3	5-6 4	5-6 5 or more
7-10	7-10 1	7-10 2	7-10 3	7-10 4	7-10 5 or more
11-13	11-13 1	11-13 2	11-13 3	11-13 4	11-13 5 or more
14-16	14-16 1	14-16 2	14-16 3	14-16 4	14-16 5 or more
17-18	17-18 1	17-18 2	17-18 3	17-18 4	17-18 5 or more

Other (please specify)

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* 9. How old was your motherless daughter(s) when you began your caretaking role?

	child 1	child 2	child 3	child 4	child 5
Under 1	Under 1 child 1	Under 1 child 2	Under 1 child 3	Under 1 child 4	Under 1 child 5
2-4	2-4 child 1	2-4 child 2	2-4 child 3	2-4 child 4	2-4 child 5
5-6	5-6 child 1	5-6 child 2	5-6 child 3	5-6 child 4	5-6 child 5
7-10	7-10 child 1	7-10 child 2	7-10 child 3	7-10 child 4	7-10 child 5
11-13	11-13 child 1	11-13 child 2	11-13 child 3	11-13 child 4	11-13 child 5
14-16	14-16 child 1	14-16 child 2	14-16 child 3	14-16 child 4	14-16 child 5
17-18	17-18 child 1	17-18 child 2	17-18 child 3	17-18 child 4	17-18 child 5

Other (please specify)

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* 10. What is your relationship to the motherless daughter(s)?

	child 1	child 2	child 3	child 4	child 5
Maternal Grandmother	Maternal Grandmother child 1	Maternal Grandmother child 2	Maternal Grandmother child 3	Maternal Grandmother child 4	Maternal Grandmother child 5
Paternal Grandmother	Paternal Grandmother child 1	Paternal Grandmother child 2	Paternal Grandmother child 3	Paternal Grandmother child 4	Paternal Grandmother child 5
Aunt	Aunt child 1	Aunt child 2	Aunt child 3	Aunt child 4	Aunt child 5
Sister	Sister child 1	Sister child 2	Sister child 3	Sister child 4	Sister child 5
Foster Mother	Foster Mother child 1	Foster Mother child 2	Foster Mother child 3	Foster Mother child 4	Foster Mother child 5
Friend of family	Friend of family child 1	Friend of family child 2	Friend of family child 3	Friend of family child 4	Friend of family child 5

Other (please specify)

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* 11. Which best indicates the circumstance that brought the motherless daughter(s) to you?

	child 1	child 2	child 3	child 4	child 5
Mother loss occurred through sudden death	Mother loss occurred through sudden death child 1	Mother loss occurred through sudden death child 2	Mother loss occurred through sudden death child 3	Mother loss occurred through sudden death child 4	Mother loss occurred through sudden death child 5
Mother loss occurred through death due to disease or illness	Mother loss occurred through death due to disease or illness child 1	Mother loss occurred through death due to disease or illness child 2	Mother loss occurred through death due to disease or illness child 3	Mother loss occurred through death due to disease or illness child 4	Mother loss occurred through death due to disease or illness child 5
Mother loss due to emotional absence but mother still living	Mother loss due to emotional absence but mother still living child 1	Mother loss due to emotional absence but mother still living child 2	Mother loss due to emotional absence but mother still living child 3	Mother loss due to emotional absence but mother still living child 4	Mother loss due to emotional absence but mother still living child 5

Other (please specify)

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* 12. Please indicate the area(s) have impacted you since entering your role as caretaker.

Career/employment

Emotionally

Financially

Increased Stress

Legally

Marital or Relationship with Significant Other

Relationship with Other Children

Relationship with Parent(s) of the children

Social/Friendships

Spirituality

Other (please specify)

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* 13. Please indicate your preferred format for a support group.

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* 14. Based on your preferred format, please check the following choices.

Monday 9:00 am - 10:30 am

Monday 1:00-2:30 PM

Monday 7:00-8:30 PM

Thursday 9:00-10:30 am

Thursday 1:00-2:30 PM

Thursday 7:00-8:30 PM

Saturday 9:00-10:30 am

Saturday 1:00-2:30 pm

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* 15. Please indicate the frequency that you would like to meet.

weekly

twice a month

monthly

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* 16. Please share with your contact information.

Name

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number