single parent questionnaire
SPAN Questionnaire for Single Parent Engagement
Please email the questionnaire to info@spanuk.org.uk Tell us about yourself - Please tick all that are relevant
Reasons for single parenthood
Age
Divorced
15- 24
Widowed
25 – 44
Never married
45+
Other
Are you a
Single/Lone Mother
Single/Lone Father
What is your ethnic background?
Asian/British Asian
Multiple Heritage
Black/Black British
Other
Chinese
Don’t wish to say
White
Are you
Employed Part-time
Disabled
Employed Full-time
Carer
Unemployed
Student
Are you claiming
Jobseekers Allowance (JSA)
Tax credits
Employment Support Allowance (ESA)
Income Support
What is your annual income?
Under £15,000 pa
Between £25,000-£40,000 pa
Between £15,000-£25,000 pa
Above £40,000 pa
If you are happy to give us your postcode please state.
Where do you live?
Village/rural area
Town or city
Housing estate outside of town/city
Have any of the following caused you major stress? Please tick all that are relevant
Domestic violence/abuse
Employment
Benefits
Housing
Poverty
Parenting
Relationship with ex partner
Being a new parent/Issues with young children
Health
Issues with Teenagers
Education/training
Childcare
Discrimination – please state in which area of your life
Other - please explain
Based on your answers above can you highlight in order of importance (1 as highest) up to 3 issues that have caused you the greatest stress.
1.
2.
3.
Where would you look for support/information? Please tick all that are relevant
Local Support Groups
Family
Internet groups/advice
Friends
Sure Start
School Health Centre
School Learning Mentor
Doctor
Notice-boards/Flyers
TSSA
Word of mouth
Church or Religious
Please email the questionnaire to info@spanuk.org.uk Tell us about yourself - Please tick all that are relevant
Reasons for single parenthood
Age
Divorced
15- 24
Widowed
25 – 44
Never married
45+
Other
Are you a
Single/Lone Mother
Single/Lone Father
What is your ethnic background?
Asian/British Asian
Multiple Heritage
Black/Black British
Other
Chinese
Don’t wish to say
White
Are you
Employed Part-time
Disabled
Employed Full-time
Carer
Unemployed
Student
Are you claiming
Jobseekers Allowance (JSA)
Tax credits
Employment Support Allowance (ESA)
Income Support
What is your annual income?
Under £15,000 pa
Between £25,000-£40,000 pa
Between £15,000-£25,000 pa
Above £40,000 pa
If you are happy to give us your postcode please state.
Where do you live?
Village/rural area
Town or city
Housing estate outside of town/city
Have any of the following caused you major stress? Please tick all that are relevant
Domestic violence/abuse
Employment
Benefits
Housing
Poverty
Parenting
Relationship with ex partner
Being a new parent/Issues with young children
Health
Issues with Teenagers
Education/training
Childcare
Discrimination – please state in which area of your life
Other - please explain
Based on your answers above can you highlight in order of importance (1 as highest) up to 3 issues that have caused you the greatest stress.
1.
2.
3.
Where would you look for support/information? Please tick all that are relevant
Local Support Groups
Family
Internet groups/advice
Friends
Sure Start
School Health Centre
School Learning Mentor
Doctor
Notice-boards/Flyers
TSSA
Word of mouth
Church or Religious