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* 1. What would you like people to say about you at your funeral?

* 2. How does writing that make you feel?

* 3. If you had a time machine how would you use it? You can't change history, you can only observe it.

* 4. Please write as many of these as you feel like:

I'm supposed to feel ________ about _________, but I don't. I feel ___________.

For example: I'm supposed to feel excited about getting promoted, but I don't. I feel overwhelmed.

Feel free to elaborate and list as many as you'd like.

* 5. How does it make you feel to write your real feelings out?

* 6. Do you think you're abnormal for feeling what you do?

* 7. Would knowing other people feel the same way make you feel better about yourself?

* 8. Because this survey is about private feelings, absolutely no personal information is being gathered about you - only your responses to these questions - not even the I.P. address of your computer. Please come up with a nickname to hide your identity in the event I use your responses on the show or outside of it. If you are feeling suicidal PLEASE call the Suicide Prevention Hotline 800-273-8255.

* 9. What gender are you?

* 10. Are you gay, straight, bisexual or asexual (not interested in either sex)?

* 11. How old are you?

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