Survey 1 - Where We Come From & Who We Are 2013 - Cause2Care4

Question 1

Which of the following descriptions best characterizes you?                                                                      

 Successful, Happy, and Independent

 Sociably Withdrawn, Paranoid, and Introverted

Caring, Emotional, and Understanding

 Procrastinator, Lazy, and Unmotivated

Easy Going, Peaceful, and Content

Victimized, Unhappy, and Suicidal

Question 2

Please rate the importance to you of the following possible reasons

 (Please rate on a scale of not important to very important)

Answer for Question 2

	Completely unimportant	Mostly unimportant	Somewhat important	Mostly important	Extremely important
Helping to stop homelessness
Having the best of everything in life
Community based fellowship and equal rights
Finding out how to help people with mental illnesses
Ability to make a difference in ending Child Abuse

Question 3

How many siblings do you have

0 (I’m an only)

1-3

4-6

7-9

10-12

13-15

>15

Question 4

Please indicate your gender.

Male

Female

Prefer not to say

Question 5

Please indicate your age group.

17 or under

18-25 years

26-35 years

36-45 years

46-55 years

56-65 years

66-75 years

76 and over

Question 6

Please indicate your highest level of education.

Less than high school

Completed high school

Completed some post-secondary education but did not earn a degree

Completed post-secondary education (college or university degree)

Completed post-graduate education (masters or doctoral degree)

Question 7

Please indicate the region of the world in which you live.

North America

South America

Africa

Australia

Europe

Asia

Question 8

Growing up would you say your home environment was....

A Positive,Safe and Secure

Normal as the rest

Traumatic because of Abuse

Negative with long lasting effects

None of Above

Please explain if choice was none of above......

Question 9

Was any of th following a feature of your childhood?

Sexual Abuse

Physical Abuse

Emotional Abuse.

Neglect .

None of Above

Question 10

At what age was of your first memory recollection

0

1-3

4-6

7-9

>10

Question 11

How many Relationships have you been in since adolescence? 

0

1-3

4-6

7-9

>10

Question 12

At which age did you have your first sexual relation, other than abuse?

As a adolescent 8-12

As a teen 13-15

After Drivers License 16-17

As an Adult before marriage

>After marriage

Question 13

How would you describe your income level within your own community?

My income is above average for my community.

My income is average for my community.

My income is below average for my community.

Question 14

Was your parents .....

Married

Divorced

Single Parent.

Question 15

Please use this space to tell us anything else you'd like us to know about you or about how your childhood may have affected you today.

Answer for Question 15