SALT&LIGHT + THIR.ST CIRCUIT-BREAKER CHECK-IN We hope you can give 5-10 minutes of your time to fill in this survey form for us to have a better understanding of how you are coping. The findings will help inform church leaders’ decisions in this Circuit Breaker and beyond. No personal data will be collected in the course of this survey. ABOUT YOU Question Title * 1. Gender M F Question Title * 2. Age 17 Years Old & below 18-25 Years Old 25-34 Years Old 35-44 Years Old 45-54 Years Old 55-64 Years Old 65+ Years Old Question Title * 3. Marital Status Not married Married Divorced Widowed Question Title * 4. Are you a parent? Check all that apply. No I have a child/children aged 0-6 I have a child/children aged 7-12 I have a child/children aged 13-21 I have adult children Question Title * 5. What best describes your employment status? Salaried worker Freelance worker/Self-employed Unemployed Student Homemaker Retired Question Title * 6. How long have you been a Christian? I am not a Christian 0-5 years 6-10 years 11-20 years 21 or more years Question Title * 7. Are you part of a Cell Group? (aka Life Group, Discipleship Group) Yes No Next