What you have to say is important!

I am concerned about the direction America is headed and I think you can help turn this country around by making your voice heard.

I am hoping to put together a presentation for adults to encourage them to be better parents. Your name will not be used, but I would like to let them know what "their kids" are saying and feeling. Please provide your email address so I can talk to you further if need be.

Thanks for your help!!

Your name:

Your email address:

1) How old are you?

12 or younger

13 or 14 years old

Between 15 and 18 years old

19 or older

2) Who do you live with (mom, step dad, dad on weekends, etc)?

3) Which member(s) of your family work?

4) How would you classify your family's financial status

low-income

middle-income

high-income

don't know

5) Has anyone in your immediate family died?

no

yes

If yes, who?

6) Have you ever attempted suicide?

no

yes

7) If parents love their children, how can they show it?

8) Do you feel your parents love you?

no

yes

9) Who in your life, do you feel, loves you the most?

10) If you could tell your parents anything, what would it be?

11) Additional Comments or your ideas on how to stop the violence:

12) Can I use your comments (without your name) in my presentation?

no

yes

Return to beginning

Go to Adult Page

Go to Links for more infomation

Hosted by www.Geocities.ws