CHILD INFORMATION FORM

ID#________

Child's Name:___________________________________ Child #:___________

Now I'd like to ask you a few questions about __________________.

CH1. During the past 12 months, about how often did you have any contact with your child either in person or by letter or phone ?

________ per week _______ per month ______ per year (19____)

_______ co-reside _________ never (last time 19____)

CH2. How much did you influence his/her education by your own example? Was it a lot, a little, or not at all?

CH3. To what extent do you take credit for how s/he has done in his/her education?

CH4. How responsible do you feel for any shortcomings in how s/he has done in education?

CH5. How close would you say you are to your child? Would you say very close, somewhat close, not very close, or not at all close?

CH6. In terms of your general outlook on life, would you say you and your child share very similar views, somewhat similar views, not very similar views, or not at all similar views?

CH7. How much education does your child have? Please be as specific as possible. (e.g. a high school diploma, a bachelor's degree, law degree, vocational school certificate, etc.)

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CH8. What kind of work does your child do? Please describe his or her current job. If your child is not currently employed, we would like to know what he or she does with most of their time, such as raising children, or attending school.

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CH9 What is your child's current marital status? Single, single but living with a partner, married, divorced,

separated or widowed?

CH10a. In this section, we want you to compare yourself with your child when you were about his/her age. Think back to 19____, when you were ____ years old. Try to recall where you were living and what you were doing. First think about work. Is your child doing much better, better, the same, worse, or much worse than you were at that age?

CH10b. What about finances? Is s/he doing much better, better, the same, worse, or much worse?

CH10c. What about education? Is s/he doing much better, better, the same, worse, or much worse?

CH10d. What about in terms of marriage or family life ? Is s/he doing much better, better, the same, worse, or much worse?

C11. Please continue to think back to 19____, when you were ____ years old. We'd like you to think about your occupational and educational accomplishments in general. Why do you think that you have generally done (better than/worse than/the same as) [child name] in terms of your career, education, and finances? What are some of the reasons that your lives have turned out (differently/the same)? (Probe: Could you tell me more about that?)

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CH12. Still thinking back to 19____, when you were ____ years old, why do you think that you have generally done (better than/worse than/the same as) [child name] in terms of your family and personal life ? What are some of the reasons that your lives have turned out (differently/the same)? (Probe: Could you tell me more about that?)

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CH13. Does your child have any developmental disabilities, or chronic physical or mental health problems? By developmental disability, we mean conditions such mental retaradation, cerebral palsy, autism, or other types of conditions that might require special education services. By chronic mental health problems, we mean depression, schizophrenia, alcoholism, anorexia, and other mental illnesses. By chronic physical health problems, we mean any long-term illness or disability. If yes, please describe this condition.

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CH14. Using a scale from 0 to 10 where 0 means "the worst possible relationship" and 10 means "the best

possible relationship," how would you rate your overall relationship with your child these days?

(0-10)_________