Childhood Socioeconomic Perceptions Survey Form

Childhood Socioeconomic Perceptions Survey Form
Please answer the following questions about your perceptions and experiences of your childhood socioeconomic background. Your responses are anonymous and will help us better understand childhood socioeconomic factors.
How would you describe your family's socioeconomic status during your childhood?
Other
What was the highest level of education completed by either of your parents or primary caregivers?
Other
What was the main occupation of your parent(s) or primary caregiver(s) during your childhood?
Other
Which of the following best describes your household structure during most of your childhood?
Other
How often did you have access to the following resources during your childhood?
Rows Never Rarely Sometimes Often Always
Nutritious food
Safe housing
Healthcare
Books and educational materials
Extracurricular activities

Please indicate your level of agreement with the following statements about your childhood neighborhood.

Rows	Strongly disagree	Disagree	Neutral	Agree	Strongly agree
I felt safe in my neighborhood.
There were opportunities for recreation.
My neighbors supported each other.
My neighborhood had good schools.

How would you rate your overall childhood environment?
Did your family ever experience periods of economic hardship during your childhood?
If you would like to share any additional thoughts about your childhood socioeconomic background, please use the space below.
Should be Empty:

Select theme:

Rows	Never	Rarely	Sometimes	Often	Always
Nutritious food
Safe housing
Healthcare
Books and educational materials
Extracurricular activities