Address: 2004 Waverly Street
Pittsburgh, PA 15218
Phone: 412.271.0185
Fax: 412.421.3675
EMail: childadvocacyn@yahoo.com

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We at the Children's Advocacy Network want to thank you in advance for taking the time to fill out our survey. Fill out only as much as you feel comfortable with but remember, the more information you give us the more we will be able to help you and others in similar situations. If you need more room for an explanation, please attach a separate sheet of paper to the back of the survey. Include your name in the upper right hand corner and indicate the question number you are referring to. We hope this survey will help us be able to help mothers and women like you who have found themselves in any family court situations. We want you to know that you are not alone, most of us here have lost our children more than 75% of the year to controlling fathers/ex-spouses who were and are more interested in the monetary value of the children than their emotional, physical, mental and spiritual well being. We are trying to make a difference and with your help we think that we can start accomplishing the goals we have set forth for C.A.N.

For a printable version of the survey, please click on one of the following
Microsoft Word Document (45 KB)
Postscript Document, PDF (currently not available)

Check out the following website for another survey:
Custody Prep for Moms - Survey Questionaire
http://www.custodyprepformoms.org

PERMISSION TO USE SURVEY
 

I do hereby give The Children's Advocacy Network and/or MoM's TLC-support group permission to use this survey for organization purposes. By signing this agreement I understand that this information may be used for grant or study purposes but my name and contact information will be kept strictly confidential.
   
CONTACT INFORMATION
 
 
NAME:
ADDRESS:
 
COUNTY:
PHONE # 1:
PHONE # 2:
   
  Profile of women who have lost custody of children, Financial Support or Equitable Distribution through the Court System
   
  Please choose one from each category below:
        Note: This information is optional and will only be used for research or grant purposes.
                 The Children's Advocacy Network does not discriminate for any reason.
   
 
Gender:
  Female           Male
Race:
  Caucasian      African American      Hispanic (not white)
   Other: (Please Specify)
Age Group:
  Under 25        26-30        26-30      31-35
  36-40            41-45        46+

PERSONAL INFORMATION:
 
  1. What was your occupation during the marriage?            
  2. What was your spouse's occupation during the marriage?
  3. Are you currently employed?  ( Yes / No) / ( Full time / Part time)
  4. If yes, what is your current occupation?                      
  5. Was your spouse:   abusive?    Verbally?   Physically?  (check all that apply)
  6. Did you ever file a P.F.A?      ( Yes / No)  ( Founded / Unfounded)
  7. Was your spouse controlling? ( Yes / No)
   
  Using a scale of 0% (least) to 100% (most) please answer questions 8-11.
Before the divorce or separation:
 
  8. How much time did you spend with the children?                           %
  9. How much time did your spouse spend with the children?                %
  10. How much were you actively involved with the children?               %
  11. How much was your spouse actively involved with the children?     %
   
  12. If you wish, briefly describe why you feel your marriage failed below:

 
  The Courts: On Custody:
   
  13. Who is / was your Judge?        
  14. Is your case still active?          ( Yes / No)
  15. When was your case first filed?
  16. Have you had an evidentiary hearing? ( Yes / No / custody decided by parents)
               If other, please explain:
  17. If yes, when was your case decided?  
  18. Did you file an appeal with the Superior Court? ( Yes / No)
  19. If yes, was the decision: ( Affirmed / Remanded)
  20. Has your case gone any further? ( Yes / No)
                  If yes, please explain:
  21. How long did your appeals take?   (a) (b) (c)
  22. Do you feel this was a long time? ( Yes / No)
  23. How specifically did you or your children suffer because of the delays?
  24.Do you feel the lower courts abused their discretion? ( Yes / No)
  25. Did you feel any Bias against you from any judge? ( Yes / No) Gender  Racial
  26. If Yes, Please give the name of the judge and explain:
  27. Did any judge ever verbally attack or demean you in any way? ( Yes / No)
  28. If yes, please give the name of the judge and explain:
  29. If you did file a P.F.A. did the judge take this in to consideration when deciding custody?
  ( Yes / No)  If yes, please explain:
  30. Is this part of a court record? ( Yes / No)
  31. Who was your evaluator? (optional)  
  32. Did you go through Psychological Evaluations? ( Yes / No)
  33. If yes, were they favorable for You, Spouse, Both (joint)
  34. If the judge went against the advise of the psychologist, briefly explain the reasons given:
  35. Are these reasons part of a court record? ( Yes / No)
  36. Do you feel the psychologist was fair with your evaluation? ( Yes / No)
     If not please explain:
  37. How many custody Attorneys have you had? ( 1 / 2 / 3 / 4+)
  38. Referring to number 37, Did you feel any of these attorney did a good job representing "who you are" to the judge? ( Yes / No)       If Yes, how many? ( 1 / 2 / 3 / 4+)
  39. Would you recommend this attorney? Please give his/her name:
   
  The Courts: On Equitable Distribution:
   
  40. Who is / was your Judge?       
  41.When was your case first filed?
  42.Have you had an evidentiary hearing? ( Yes / No / decided by parties)
   If Other please explain:
  43. If yes, what was their decision?       
  44. If yes, when was your case decided?
  45. Did you file an appeal with the Superior Court? ( Yes / No)
  46. If yes, was their decision: ( Affirmed / Remanded)
  47. Has your case gone any further? ( Yes / No)
     If yes please explain:
  48. How long did your appeals take? (a) (b) (c)
  49. Do you feel the lower courts abused their discretion? ( Yes / No)
  50. Did you feel any Bias against you from the judge? ( Yes / No) Gender  Racial
  51. Did the judge ever verbally attack or demean you in any way? ( Yes / No)
     If yes please explain:
  52. How many attorneys have you had? ( 1 / 2 / 3 / 4+)
  53. Did you feel any of these attorney's did a good job representing your case to the judge?
     ( Yes / No) If Yes, how many? ( 1 / 2 / 3 / 4+)
   
  Financial:
   
  54. How much have you spent on Legal, evaluation fees and expenses for custody?    $
  55. How much have you spent on Legal fees and expenses for equitable distribution?  $
  56. How much have you spent on Legal fees and expenses for child support?             $
  57. Was your spouse ordered to pay any court costs? ( Yes / No)
  58. If Yes, How much?  $
  59. Do you receive child support? ( Yes / No)
  60. Do you feel you receive enough to support your child(ren)? ( Yes / No)
  61. Do you pay child support? ( Yes / No)
  62. Do you feel you received a fair amount from Equitable Distribution? ( Yes / No)
  63. Did / Do you receive Alimony? ( Yes / No)
  64. Do you feel you receive(d) a fair amount? ( Yes / No)
   
  The Children:
   
  65. How many children do you have? ( 1 / 2 / 3 / 4 / 5 / 6+)
  66. What are their present ages?                                    
  67. What ages were they when the custody action started?
  68. Briefly describe your present custody schedule and who has legal and physical custody:
  69. What are/were the reasons the judge gave for setting up your custody schedule?
  70. What are/were the reasons the judge gave for setting up your custody schedule?
  71. Are these reasons part of a court record? ( Yes / No)
  72. Do you feel you have maintained an adequate relationship with your children? (Yes/No)
  73. How difficult is it for you to maintain an adequate relationship with your children?
Please Explain:
   
  Ratings:
                                                                                                                                                     Excellent      Good          Fair           Poor
 
   
74. How do you feel the present custody arrangement is working?
75. How well do you communicate with father concerning
     children? 
76. How well does father communicate with you concerning
     children?
77. How well are you following the current custody order?
78. How well is father following the current custody order?
79. If your children live with father more than 50% of the year,
     how well do you feel father is meeting their needs:

Physically:
Emotionally:
Mentally:
Spiritually:
80. How well do you feel you are meeting your children's needs?

Physically:

Emotionally:

Mentally:

Spiritually:
81. How well do you thing your children are fairing?
Physically:
Emotionally:
Mentally:
Spiritually:
   
  82. What Date did your case begin?              
  83. How did you hear about our organization? 
  84. Was our organization able to help you?      ( Yes / No)
   
  Comments:
 
   
 

   
Thank you for completing this survey.  Please click on the Submit button to send us your survey answers.  Please email us: childadvocacyn@yahoo.com if you need more information, or need to speak with representative.