[michelleb]

QUESTIONNAIRE

(Please check the best answer)

Are you male___ female_x__

Marital Status: married_x__ single___

Age group: 20-29___ 30-39__x_ 40-49___ 50+___

Were you ever a foster child? yes___ no_x__

If yes, is this what caused you to consider becoming a foster parent yourself?

yes___ no___

Are you currently a foster parent? yes_x__ no___

If no, have you been a foster parent? yes___ no___

If no, have you decided to be a foster parent? yes___ no___

What kind of experience have you had with child care?

personal_x__ professional__x_ none___

Prior to thinking about foster parenting, did you consider adoption as a choice?

yes__x_ no___

OR

Has the foster parent system caused you to consider the option of adoption?

yes___ no___

How has (or do you think) the impact of being a foster parent been? (1-the worse experience; 5-the best experience)

1___ 2___ 3___ 4___ 5_x__

Did you experience a happy childhood? yes_x__ no___

Have your past childhood experiences influenced your choice of becoming a part of the foster parent community? yes___ no_x__

What is the confidence level of your own ability to nurture someone other than your own family? (1- no confidence; 5- very confident)

1___ 2___ 3___ 4___ 5_x__

In the following list, check the functions that you think are most important regarding family.

Physical maintenance and care of group members__x__

Addition of new members through procreation or adoption__x__

Socialization of children__x__

Social control of members_x___

Production, consumption, and distribution of goods and services_x___

Affective nurturance- love__x__

Other______________________________