Home Environment - Child Survey example

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

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1) Who do you live with?
  • Mother
  • Father
  • Mother and Father
  • Mother and Stepfather
  • Father and Stepmother
  • Other:
2) What grade are you in?
3) Are you male or female?
  • Male
  • Female
4) Do your parents have any rules about what time you have to go to bed on school nights?
  • Yes
  • No
5) Do your parents have any rules about how late you can stay out with your friends?
  • Yes
  • No
6) Do your parents have any rules about doing your homework? For instance, do you have to finish your homework before you can watch TV?
  • Yes
  • No
7) Do you have a computer in your home?
  • Yes
  • No
8) How often do you ask your parents for help with homework?
9) How often do you and your parents go to art galleries or museums?
10) How often do you and your parents go to plays or concerts?
11) How often do you go to the library?
12) How often do you go to the library with your parents?
13) Do your parents have any rules about doing household chores?
  • Yes
  • No
14) How often do your parents include you in discussions about important decisions that need to be made?
15) How often would you say your parents listen to your side of an argument?
16) How often would you say that you have a voice in making rules that concern you?
17) How often do you talk with your parents about things that happen at school?
18) What's the highest level of education you would like to achieve?
19) How far do you think you will make it in school?
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