Effects of divorce on children Please circle or fill in the banks, and do not put your name on the survey.
1. Gender: Male Female 2. Age_______ 3. What is your parents' current relationship? Married Divorced Separated Single,(Never Married) Widowed If you answered divorced please continue until the end, if not please skip to number 20 4. How old were you when the divorce was final?_________ 5. How many years have your parents been divorced? _______ 6 Was it a surprise to you that they were getting a divorce? Yes No 7. What types of problems did you think they encountered? A. Financial? Yes No Don't Know B. Verbal arguments? Yes No Don't Know C. Were they distant? Yes No Don't Know D. Conflicting schedules/ lack of time together? Yes No Don't Know E Infidelity? Yes No Don't Know 8. Who's fault was the divorce? Mom Dad Other____________ 9. How did you feel about the divorce?________________________________________ ________________________________________________________________________ 10.
What type of custody did you have?_______________________________________ 11. Who did you live with afterwards? Mom Dad Other______ 12. Who made the custody decision?________________ 13. Who do you feel closer with? Mom Dad 14. How would you describe your life at home? ________________________________ 15. How do you describe your relationship with your mother?______________________ ____________________________________________________________________ 16. How do you describe your relationship with your father?______________________ ___________________________________________________________________ 17. Do you have any siblings? Yes No A. If so how many?______ B. How many older?______ C. Younger?_____ 18. Did you go to family therapy? Yes No A. If yes, Why did you go, (Dad, Mom, You wanted to go)___________________ ___________________________________________________________________ 19. Did either of your parents remarry? Mom Dad Both Neither A. If yes, do you like your step parents.
20. What was your GPA in high school? ________ 21. How were your relationships with your friends?______________________________ ____________________________________________________________________ 22. Do you plan on: A. Getting married Yes No B. Living with a romantic partner? Yes No C. Having children? Yes No 23. What are your views on: Scale of 1-5, 1 being positive and 5 being negative A. Romantic relationships? 1 2 3 4 5 B. Dating? 1 2 3 4 5 C. Marriage? 1 2 3 4 5 D. Having Children? 1 2 3 4 5 24. Does your parents' relationship affect your views on marriage? Yes No