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Media Release Forms
Joyful Together®
Joyful Together® Follow-up
Father’s Feelings
Fathers Feelings Follow-up Interview Study
CareSource Project Forms
The Maternal Vitality Study
Maternal Vitality Study- For Women/Mothers
MVS Clinician Form
Staff Forms
PFS-2-Staff
Staff Joyful Together® Fidelity Tool
Supervisor Fidelity Process Guidance Tool
Clinical Note
Intervention Note
Closing Note
Student Intern Evaluation Projects
Initial Intern Evaluation Project Information Form & Agreement
Updated Intern Evaluation Project Form
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OhioGuidestone Research Portal
Toggle Navigation
Toggle Navigation
Home
About
Media Release Forms
Joyful Together®
Joyful Together® Follow-up
Father’s Feelings
Fathers Feelings Follow-up Interview Study
CareSource Project Forms
The Maternal Vitality Study
Maternal Vitality Study- For Women/Mothers
MVS Clinician Form
Staff Forms
PFS-2-Staff
Staff Joyful Together® Fidelity Tool
Supervisor Fidelity Process Guidance Tool
Clinical Note
Intervention Note
Closing Note
Student Intern Evaluation Projects
Initial Intern Evaluation Project Information Form & Agreement
Updated Intern Evaluation Project Form
Information Sheet
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Electronic Agreement
*
By checking this box, I agree to use electronic records and electronic signatures.
Access Code
*
Date
*
Person Completing Form
*
Mom
Dad
Other
If other, please explain
*
Gender
*
Male
Female
Non-Binary/Third-Gender/Other
Prefer not to answer
RelationshipStatus
*
Married
Partnered
Single
Widowed
Divorced
Separated
Race/Ethnicity (Please check all that apply)
*
Native American or Alaskan Native
Asian
African American
African National/Caribbean Islander
Hispanic or Latino
Middle Eastern
Native Hawaiian/Pacific Islander
White (Non-Hispanic/European American)
Multi-racial
Other
If other, please explain
*
Employment Status
*
Employed Outside of the Home
Self-Employed
Out of Work
Homemaker
Student
Retired
Unable to Work
Military
Other
If other employment, please explain
*
Parent/Caregiver Highest Level of Education
*
Some High School
High School Diploma or GED
Trade Certificate
Some College
Associate's Degree
Bachelor's Degree
Master's Degree
Professional or PhD Degree
Household Size (please include the number of children and adults in your household)
*
Household Income
*
Below $5,000
$5,000-$14,999
$15,000-$24,999
$25,000-$34,999
$35,000-$49,999
$50,000-$74,999
$75,000-$99,999
$100,000-$149,999
$150,000-$199,999
$200,000 or more
Child's Schooling Status at the Start of the Study
No School
Home or Family Care
Day Care
Pre-K/Preschool
Kindergarten
1st-2nd Grade
3rd-4th Grade
5th-6th Grade
7th-8th Grade
Child's School Name
How was this form completed?
*
In-Person
By Phone
Online
Mail-In
Website
Submit