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1. PAGE ONE:

Some background information will help us to understand your needs. Please circle your response or fill in the blank as needed.

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* 1. Please indicate your age.

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* 2. What is your sex?

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* 3. Please indicate your status (Check as many as necessary).

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* 4. How long have you been stationed at McConnell?

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* 5. Where do you live?

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* 6. Which of the following best describes your marital status?

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* 7. Are you geographically separated from your spouse, if yes where is your spouse currently stationed?

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* 8. Is your spouse employed in a job equal to his/her qualifications?

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* 9. How many children live in your home? (if you have no questions skip to question 15)

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* 10. How many of your children are:

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* 11. What are the ages of the children living with you? (Choose all that apply)

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* 12. What is the highest level of education you have attained?

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* 13. What is the highest level of education your spouse has attained?

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