Mom's Support Group Questionnaire

Combining the roles of mother (father)hood and being a college student is quite a juggling act. The University of Louisville’s Women’s Center MOMS group is providing a questionnaire to get feedback from you regarding a support group for student-parents. Complete the form and click submit at the bottom of the page.

If for any reason you would prefer to download the form and submit it via e-mail to Women’s Center Service account at womenctr@louisville.edu and/or to Phyllis M. Webb, phyllis.webb@louisville.edu, you may do that here.

Name First & Last

Your E-Mail Address

Phone Number

Best time to call

Classification

Major

Minor

Career Goals

Expected Graduation Date/Completion

Status

Single student-parent
Married student-parent

Your age

Under 21
21-35
Over 35

Number of Children

Comments List at least 5 activities you would like to see the group involved with:

What do you hope to accomplish by taking part in this group?

What are some areas that you would like to improve in as a student and/or parent?

Favorite activities/hobbies/interests: List 4

Please enter the text below:

Women's Center

Mom's Support Group Questionnaire

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