"Different from Mother" Survey"Different from Mother" Survey

*

1. We would like to be able to contact you for follow-up interviews.

We would like to be able to contact you for follow-up interviews. Name:
Street Address:
City/Town:
State/Province:
ZIP/Postal Code:

*

2. Phone Number:

Phone Number:

*

3. Email Address:

Email Address:

*

4. Date of Birth:

Date of Birth:

*

5. Ethnicity:

Ethnicity:

*

6. Are you currently:

Are you currently: Married

Divorced

Widowed

Never Married

*

7. Occupation:

Occupation:

*

8. Is your life different from your mother's? Please select Yes or No, then answer why.

Is your life different from your mother's? Please select Yes or No, then answer why. Yes

No

Why?

*

9. Is this good or bad? Please select Good or Bad, then answer why.

Is this good or bad? Please select Good or Bad, then answer why. Good

Bad

Why?

*

10. Do you control your own money?

Do you control your own money? Yes

No

*

11. Do you know where your assets are located?

Do you know where your assets are located? Yes

No

*

12. Do you have a will?

Do you have a will? Yes

No

13. If you are married, how do you make decisions?

If you are married, how do you make decisions?

14. How do you feel about that?

How do you feel about that?

15. If you are single, how do you make decisions?

If you are single, how do you make decisions?

*

16. How do you describe your primary identity at this stage in your life?

How do you describe your primary identity at this stage in your life? Working Woman

Homemaker

Old Woman

Middle-Aged

Wise Woman

Successful

Unfulfilled

*

17. With which of the following statements do you agree:

With which of the following statements do you agree: After age 50, women have more opportunities to make choices today.

After age 50, women have few opportunities to make choices today.

Mature women are valued for their experience and wisdom.

Mature women have less value because society values youth.

18. If you are not in a committed relationship, do you believe you will have such a relationship in the future? Please select Yes or No, then answer why.

If you are not in a committed relationship, do you believe you will have such a relationship in the future? Please select Yes or No, then answer why. Yes

No

Why?

*

19. After age 70, I plan to:

After age 70, I plan to: Stay where I am

Move to be near family

Move to a retirement community

*

20. Do you have a network of friends with whom you meet at least twice a month?

Do you have a network of friends with whom you meet at least twice a month? Yes

No

21. If you work, what is your ambition?

If you work, what is your ambition?

22. If you plan to volunteer, describe the activity that most interests you.

If you plan to volunteer, describe the activity that most interests you.

*

23. What are your goals as you enter your mature years? (Examples: to travel, to play bridge, to return to school) Please tell why you have waited to pursue these activities.

What are your goals as you enter your mature years? (Examples: to travel, to play bridge, to return to school) Please tell why you have waited to pursue these activities.

*

24. Do you expect to have different challenges as you age, such as caregiving for your spouse or your aging parents, raising grandchildren, cope with disease? Please select Yes or No, then answer why.

Do you expect to have different challenges as you age, such as caregiving for your spouse or your aging parents, raising grandchildren, cope with disease? Please select Yes or No, then answer why. Yes

No

Why?

*

25. Are you excited about aging? Please select Yes or No, then answer why.

Are you excited about aging? Please select Yes or No, then answer why. Yes

No

Why?

*

26. Are you afraid? Please select Yes or No, then answer why.

Are you afraid? Please select Yes or No, then answer why. Yes

No

Why?

*

27. What one word best describes your attitude toward aging?

What one word best describes your attitude toward aging?

*

28. May we contact you for additional comments?

May we contact you for additional comments? Yes

No

*

29. May we add you to our mailing list?

May we add you to our mailing list? Yes

No