* Indicates required questions.

0%

1. How likely are you to choose the following? *

	Not At All	Somewhat	Very
Parenting
Adoption
Abortion
Guardianship / Kinship Care
Safe Haven

2. How far along are you in your pregnancy? *

1-3 Months
4-6 Months
7-9 Months
I am unsure if I am pregnant

3. Was this a planned or unplanned pregnancy? *

Planned
Unplanned
I am unsure if I am pregnant

4. How old are you? *

14 or younger
15 - 17
18 - 21
22 - 25
26 - 30
31 or older

5. Are you currently employed? *

Yes
No

6. What is your highest level of education? *

Jr High
High School
Some College
Bachelor's Degree
Master's Degree
Doctorate

7. What best describes your relationship with the father? *

Boyfriend / Girlfriend
Engaged
Married
Casual friendship
No communication
Rape / Incest
Other

8. Who have you talked with for advice? (select all that apply) *

Parents
Friends
Family Members
Religious Leader
School Counselor
Private Counselor
Adoption Agency
Adoption Attorney
Adoption Facilitator
Pregnancy Counselor / Center
Abortion Clinic
Physician
Other
No One

9. Are you currently parenting a child? *

Yes
No

10. Have you previously had an abortion? *

Yes
No
Do not wish to disclose