Childhood Socioeconomic Survey Form
Please answer the following questions about your childhood household and environment. Your responses will remain anonymous and are vital for understanding socioeconomic backgrounds.
How many people lived in your childhood household (including yourself)?
*
Please Select
1
2
3
4
5
6 or more
What was the highest level of education completed by your primary caregiver(s) during your childhood?
*
No formal education
Some primary/elementary school
Completed primary/elementary school
Some secondary/high school
Completed secondary/high school
Some college or vocational training
Completed college or higher
Other
Which of the following best describes the main occupation of your primary caregiver(s) during your childhood?
*
Unemployed
Manual labor/skilled trade
Clerical/administrative
Professional/managerial
Business owner/self-employed
Homemaker
Other
What type of home did you mostly live in during your childhood?
*
Owned house/apartment
Rented house/apartment
Public or subsidized housing
Lived with relatives/friends
Other
Did your household have consistent access to the following during your childhood?
*
Rows
Always
Sometimes
Rarely
Never
Enough food
1
2
3
4
Safe drinking water
5
6
7
8
Electricity
9
10
11
12
Heating/cooling
13
14
15
16
Telephone or internet
17
18
19
20
How would you rate your family's financial situation during your childhood compared to others in your community?
*
Much worse off
1
2
3
4
5
6
Much better off
7
1 is Much worse off, 7 is Much better off
Did you receive any of the following forms of assistance during your childhood? (Select all that apply)
Free or reduced school meals
Government assistance (e.g., food stamps, housing aid)
Charity or community support
None
Other
Did your family own a car during your childhood?
Yes, always
Sometimes
No
Did you have your own bedroom during your childhood?
Yes, always
Sometimes
No
Is there anything else you would like to share about your childhood socioeconomic experience?
Submit Survey
Should be Empty: