Home Environment - Parent Survey example

This is an example Home Environment - Parent Survey survey. This survey includes questions like:

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1) Please tell us about your family composition.
2) How many children are in your family?
3) Please tell us the ages of all the children in your household. Check as many as apply.
  • Under 1 year
  • 1-4 years
  • 5-7 years
  • 8-10 years
  • 11-13 years
  • 14-17 years
  • 18 and older
4) Do you have rules about what time your children go to bed on school nights?
  • Yes
  • No
5) Do you have rules about what time your children are to be home on school nights?
  • Yes
  • No
6) Do you have rules regarding homework?
  • Yes
  • No
7) Do you have rules about the amount of television viewing your children are allowed during the week?
  • Yes
  • No
8) How often do you talk to your child(ren) about important family decisions?
9) How often do you help your child(ren) with his/her homework?
10) How often do you visit the library with your child(ren)?
11) How often do you visit a museum or art gallery with your child(ren)?
12) How often do you see a play, concert, or other performance with your child(ren)?
13) Does your child have a quiet place to study?
  • Yes
  • No
14) Approximately how many books do you own?
15) Are you actively involved in any community service?
  • Yes
  • No
16) Are your child(ren) actively involved in any community service?
  • Yes
  • No
17) Do you own a computer?
  • Yes
  • No
18) How often do you talk with your child(ren) about things he/she does at school?
19) How often do you read to/with your child(ren) during the week?
20) Do you have rules about household chores?
  • Yes
  • No
21) What is your age?
22) Are you male or female?
  • Male
  • Female
23) What is your race?
24) Do you have a spouse?
  • Yes
  • No
25) If yes, what is your spouse's race?
26) What is your total household income including all earners in your household?
27) What is the highest level of education you have completed?
28) What is the highest level of education your spouse has achieved?
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