AAPI2_1_Form_A_English (7) (1)
1.Date Inventory was administered
-
Month
-
Day
Year
Date
Email Address of Staff Member administering Inventory
2. First Name
3. Middle Initial
4. Last Name (or ID)
Agency Name
City
State
5. Birthday
-
Month
-
Day
Year
Date
6. Gender
a. Male
b. Female
c. Transgender Man
d. Transgender Woman
e. Other
7. Race/ Nationality
a. White
b. Black
c. Asian
d. Hispanic
e. Native American
f. Pacific Islander
g. Bi- Racial
h. Multi-Racial
i. Other
Nationality:
8. Marital Status:
a. Single
b. Married
c. Unmarried Partners
d. Separated/ Divorced
e. Widow/ Widower
9. Number of children you have:
10. Highest grade you completed:
a. Grade School
b. Middle School (grades 7 &8)
c. Some High School (grades 9 -11)
d. High School Graduate
e. Working on OR Completed GED
f. Two Year Tech School
g. Some College
h. College Graduate
Post Graduate or Above
11. Current Employment- School Status:
a. Employed full-time
b. Going to school full time
c. Employed part-time
d. Going to school part time
e. Both going to school and working
f. I am a stay at home Mom or Dad
g. Currently unemployed and not going to school
h. Retired
i. Other
12. Annual Household Income
a. Under $15,00
b. $15,001 to $25,000
c. $25,001 to $30,000
d. $30,001 to $40,000
e. $40,001 to $60,000
f. Over $60,000
g. I don’t know
13. Are/ were you or your partner in the military?
a. Yes, Only me
b. Yes, Only my partner
c. Yes, Both of us
d. No
14. As a child, did you experience any type of physical, emotional or sexual abuse by someone outside your family?
a. Yes
b. No
15. As a child, did you experience any type of physical, emotional or sexual abuse by someone inside your family?
a. Yes
b. No
INSTRUCTIONS:
There are 40 statements in this booklet. They are statements about parenting and raising children. You decided the degree to which you agree or disagree with each statement by circling one of the responses.
STRONGLY AGREE
Circle SA if you strongly support the statement, or feel the statement is true most of all the time
AGREE
Circle A if you support the statement, or feel this statement is true some of the time
STRONGLY DISAGREE
Circle SD if you feel strongly againts the statement, or feel the statement is not true.
DISAGREE
Circle D if you feel you cannot support the statement or that the statement is not true some of the time.
UNCERTAIN
Circle U only when it is impossible to decide on one of the other choices.
When you are told to turn the page, Begin with number 1 and go until you finish all the statements. In answering them, please keep these four points in mind:
1. Respond to the statements truthfully. There is no advantage in giving an untrue response because you think it is the right thing to say. There really is no right or wrong answer- only your opinion.
2. Respond to the statements as quickly as you can. Give the first natural response that comes to mind.
3. Circle only one response for each statement.
4. Although some statements may seem much like others, no two statements are exactly alike. Make sure you respond to every statement.
If there is anything you don't understand, please ask your questions now. If you come across a word you don't know while responding to a statement, ask the examiner for help.
PLEASE TURN THE PAGE AND BEGIN
1. Children need to be allowed freedom to explore their world in safety.
SA- Strongly Agree
A- Agree
D- Disagree
SD- Strongly Disagree
U- Uncertain
2. Time-out is an effective way to discipline children.
SA- Strongly Agree
A- Agree
D- Disagree
SD- Strongly Disagree
U- Uncertain
3. Children who are one-year-old should be able to stay away from things that could harm them.
SA- Strongly Agree
A- Agree
D- Disagree
SD- Strongly Disagree
U- Uncertain
4. Strong-willed children must be taught to mind their parents.
SA- Strongly Agree
A- Agree
D- Disagree
SD- Strongly Disagree
U- Uncertain
5. The sooner children learn to feed and dress themselves and use the toilet, the better off they will be as adults.
SA- Strongly Agree
A- Agree
D- Disagree
SD- Strongly Disagree
U- Uncertain
6. Spanking teaches children right from wrong.
SA- Strongly Agree
A- Agree
D- Disagree
SD- Strongly Disagree
U- Uncertain
7. Babies need to learn how to be considerate of the needs of their mother.
SA- Strongly Agree
A- Agree
D- Disagree
SD- Strongly Disagree
U- Uncertain
8. Strict discipline is the best way to raise children.
SA- Strongly Agree
A- Agree
D- Disagree
SD- Strongly Disagree
U- Uncertain
9. Parents who nurture themselves make better parents.
SA- Strongly Agree
A- Agree
D- Disagree
SD- Strongly Disagree
U- Uncertain
10. Children can learn good discipline without being spanked.
SA- Strongly Agree
A- Agree
D- Disagree
SD- Strongly Disagree
U- Uncertain
11. Children have a responsibility to please their parents.
SA- Strongly Agree
A- Agree
D- Disagree
SD- Strongly Disagree
U- Uncertain
12. Good children always obey their parents.
SA- Strongly Agree
A- Agree
D- Disagree
SD- Strongly Disagree
U- Uncertain
13. In father's absence, the son needs to become the man of the house.
SA- Strongly Agree
A- Agree
D- Disagree
SD- Strongly Disagree
U- Uncertain
14. A good spanking never hurt anyone.
SA- Strongly Agree
A- Agree
D- Disagree
SD- Strongly Disagree
U- Uncertain
15. Parents need to push their children to do better.
SA- Strongly Agree
A- Agree
D- Disagree
SD- Strongly Disagree
U- Uncertain
16. Children should keep their feelings to themselves.
SA- Strongly Agree
A- Agree
D- Disagree
SD- Strongly Disagree
U- Uncertain
17. Children should be aware of ways to comfort their parents after a hard day's work.
SA- Strongly Agree
A- Agree
D- Disagree
SD- Strongly Disagree
U- Uncertain
18. Children learn to respect through strict discipline.
SA- Strongly Agree
A- Agree
D- Disagree
SD- Strongly Disagree
U- Uncertain
19. Hitting a child out of love is different than hitting a child out of anger.
SA- Strongly Agree
A- Agree
D- Disagree
SD- Strongly Disagree
U- Uncertain
20. A good child sleeps through the night.
SA- Strongly Agree
A- Agree
D- Disagree
SD- Strongly Disagree
U- Uncertain
21. Children should be potty trained when they are ready and not before.
SA- Strongly Agree
A- Agree
D- Disagree
SD- Strongly Disagree
U- Uncertain
22. A certain amount of fear is necessary for children to respect their parents.
SA- Strongly Agree
A- Agree
D- Disagree
SD- Strongly Disagree
U- Uncertain
23. Spanking teaches children it's alright to hit others.
SA- Strongly Agree
A- Agree
D- Disagree
SD- Strongly Disagree
U- Uncertain
24. Children who feel secure often grow up expecting too much.
SA- Strongly Agree
A- Agree
D- Disagree
SD- Strongly Disagree
U- Uncertain
25. There is nothing worse than a strong-willed two year-old.
SA- Strongly Agree
A- Agree
D- Disagree
SD- Strongly Disagree
U- Uncertain
26. Sometimes spanking is the only thing that will work.
SA- Strongly Agree
A- Agree
D- Disagree
SD- Strongly Disagree
U- Uncertain
27. Children who receive praise will think too much of themselves.
SA- Strongly Agree
A- Agree
D- Disagree
SD- Strongly Disagree
U- Uncertain
28. Children should do what they're told to do, when they're told to do it. It's that simple.
SA- Strongly Agree
A- Agree
D- Disagree
SD- Strongly Disagree
U- Uncertain
29. Children should be taught to obey their parents at all times.
SA- Strongly Agree
A- Agree
D- Disagree
SD- Strongly Disagree
U- Uncertain
30. Children should know what their parents need without being told.
SA- Strongly Agree
A- Agree
D- Disagree
SD- Strongly Disagree
U- Uncertain
31. Children should be responsible for the well-being of their parents.
SA- Strongly Agree
A- Agree
D- Disagree
SD- Strongly Disagree
U- Uncertain
32. It's OK to spank as a last resort.
SA- Strongly Agree
A- Agree
D- Disagree
SD- Strongly Disagree
U- Uncertain
33. Parents should be able to confide in their children.
SA- Strongly Agree
A- Agree
D- Disagree
SD- Strongly Disagree
U- Uncertain
34. Parents who encourage their children to talk to them only end up listening to complaints.
SA- Strongly Agree
A- Agree
D- Disagree
SD- Strongly Disagree
U- Uncertain
35. Children need discipline, not spanking.
SA- Strongly Agree
A- Agree
D- Disagree
SD- Strongly Disagree
U- Uncertain
36. Letting a child sleep in the parent's bed every now and then is a bad idea.
SA- Strongly Agree
A- Agree
D- Disagree
SD- Strongly Disagree
U- Uncertain
37. A good spanking lets children know parents mean business.
SA- Strongly Agree
A- Agree
D- Disagree
SD- Strongly Disagree
U- Uncertain
38. A good child will comfort both parents after they have argued.
SA- Strongly Agree
A- Agree
D- Disagree
SD- Strongly Disagree
U- Uncertain
39. "Because I said so" is the only reason parents need to give.
SA- Strongly Agree
A- Agree
D- Disagree
SD- Strongly Disagree
U- Uncertain
40. Children should be their parents best friend.
SA- Strongly Agree
A- Agree
D- Disagree
SD- Strongly Disagree
U- Uncertain
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