Divorce

Please change the colour of and/or underline your answers.

1. Are you male or female?
a) Male
b) Female

2. What is your age?
a) Less than 12
b) 13-17
c) 18+

3. Your parents are currently:
a) Divorced
b) Separated
c) Married

4. Do you feel like you get to spend enough time with your Mom?
a) Yes
b) No

5. Do you feel like you get to spend enough time with your Dad?
a) Yes
b) No

6. How well do your parents get along on a scale of 1-10?


7. How understanding are your parents to your OWN relationship problems, on a scale of 1-5?

8. How would you order your parents priorities: Their work life, their home life, your school life, your home life? (One being highest priority, four being lowest)
1-
2-
3-
4-

9. How often do you find yourself blamed by your parents for their shortcomings?
a) Never
b) Seldom
c) Periodically
d) Often

10. You have
a) No siblings
b) One sibling
c) Two siblings
d) Three or more siblings

11. Your parents’ relationship is something you think a great deal about
a) True
b) False

12. You feel anxiety when starting new relationships
a) True
b) False

13. You worry about making relationship mistakes your parents have made
a) True
b) False

14. You find it hard to be sensitive to your peers’ feelings:
a) Never
b) Seldom
c) Periodically
d) Often

15. You are apprehensive about being in a committed relationship
a) True
b) False

16. To you, having relationships (Dating) is:
a) Unimportant
b) Somewhat important
c) Doesn’t matter
d) Important
e) Very important

17. You would describe yourself as sociable:
a) True
b) False

18. You would describe yourself as easily angered:
a) True
b) False

19. You believe in divorce:
a) True
b) False