AGE BRACKET
18-25, 26-35, 36-45, 46-55, 56-65, 66-75, and 76+
GENDER IDENTITY
Male heterosexual, Female heterosexual, Gay, Lesbian, Transgender, Transsexual, Other
RELATIONAL STATUS
Single, Cohabiting, 1st Marriage, Separated, Divorced, Remarried, Widowed
GEOGRAPHICAL AREA*
Northeast, Southeast, Midwest, Southwest, Northwest, West Coast, International, Urban, Rural
TYPE OF OCCUPATION
Unemployed, Full-time homemaker, Employed part-time, Employed full-time without benefits, Self-employed full-time w/o benefits, Employed full-time with benefits, Management supervising 1+ full-time, Business owner employing 1+ other full-time
EDUCATIONAL LEVEL
NO H.S. Diploma or GED, H.S. Diploma or GED, Associates degree, College graduate, Masters degree, Doctorate or 2 Masters degrees
INCOME LEVEL
Lower Lower class, Upper Lower, Lower Middle (homeowner), Upper Middle (homeowner out of debt and saving money), Lower Upper, Upper Upper
POLITICAL VIEWS*
Republican
Democrat
Red – concerned for the rights of businesses and traditional families
Blue – concerned for rights of all people, especially the disadvantaged
Green – wanting to protect the environment and international peace
Purple – independent, supporting best candidate running in each race
Yellow – wanting to minimize taxes and government regulations
Gray – I cannot be described by any categories above
PHYSICAL HEALTH
Five levels will be delineated: Poor, Fair, Average, Good, and Excellent
MENTAL HEALTH*
Currently being treated in a psych ward or drug rehab unit
Struggling to cope with life, using drugs or alcohol to help or numb out
Struggling to cope with life, but not relying on drugs or alcohol
My life is stable but not very satisfying
My life is stable and satisfying, but not very interesting
My frustrations are teaching me as I go, and I’m generally enjoying life
I am content and fulfilled, enjoying life as it comes
RELATIONAL HEALTH
Poor: No significant other and no close friends
Fair: Have a lover/mate but no close friends
Average: Good close friends but not in love now
Good: Married or stable love relationship supported by close friends
Excellent: Intimate with both mate and friends
SPIRITUAL HEALTH*
Devout: regular in prayer, worship, Bible study, fellowship, and service
Social: somewhat active in church/fellowship for worship and service
Spiritual: privately praying and meditating but without organized religion
Agnostic: seriously doubting validity of bible, church, and a creator god
Atheist: I believe and live as if there’s no heaven, hell, Devil, or God
12-step: I find my higher power in the people and principles of recovery
Inactive: I guess I am a believer, but most people wouldn’t be able to tell
EMAIL ADDRESS(ESS) WHERE TEST RESULTS ARE TO BE SENT
Any group wishing their own norms on this test can ask their members to have their results sent not only to the email addresses they give for their own personal feedback, but also to one for the group administrator, who can then access their own group norms to share with their members, or to compare with previous or future administrations.
* Respondents will be able to check more than one answer to these questions.