1. Informed Consent Form

This survey is anonymous to protect your privacy. This questionnaire is about different ways in which people think and feel about their experiences with groups about the issue of control. The group may be of any kind and size. Groups might include a country, religious group, political group, therapy group, business group or corporation, even a relationship or family. Please pick a group that you feel is (or was) the most controlling in your life. If you were not in a controlling group or relationship, please fill it out and answer accurately. Participation is completely voluntary. You may stop at any time. Leave a question blank if you are not sure what to answer. You do not have to complete the survey in one go, you can use the same link to complete the survey at a later time. 

We want to hear your feedback! Are there areas we have not considered? Are there thing missing, or other measures to consider? We are looking to gather raw data on aspects of the BITE model. Can it be developed into a scientific tool to measure undue influence?

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* 1. Today's Date (MM/DD/YY)

Date

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* 2. In what country do you currently reside?

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* 3. Which race/ethnicity best describes you? (Please choose only one.)

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* 4. Which of the following languages would you feel comfortable completing a survey in? (Please select all that apply.)

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* 5. Which of the following categories best describes your employment status?

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* 6. What is the highest level of education you have completed?

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* 7. What is your gender?

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* 8. What's your profession?

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* 9. Are you a former member of a high-control group?

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* 10. Are you currently a member of a high-control group?

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* 11. How long were you involved in the group?

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* 12. Were you raised as a child in the group?

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* 13. At what age did you enter the group?

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* 14. How did you exit the group?

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* 15. Do you belong to any ex-member support groups?

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* 16. Have you helped others to exit the group?

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* 17. What healthy groups do you belong to? Please list all.

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* 18. How long have you been a member of healthy groups?

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* 19. Select all the groups that you belong to from the following list and for how long.

  0 - 7 days 1 - 6 weeks 1 - 4 years 4 -7 years 7 - 10 years 10 - 14 years or more
Agni Yoga
Alamo Christian Foundation Tony Alamo
Alcoholics Anonymous
Al-Qaida
Amway
Ananda Marga
Anthroposophy
Apostles of Infinite Love Michael Collin
Apostolic Church
Art of Living Foundation
Aum Shinriko Aleph Shoko Asahara
Alamo Christian Foundation Tony Alamo
Avatar
Ayn Rand
Ayn Rand Institute
Boy Scouts
Brahma Kumari
Branch Davidians David Koresh
Brethren Jim Roberts
Bruderhof
Buddhafield
Buddhism
Calvinist
Chabad- Lubavitch
Channelers
Christian Science Mary Baker Eddy
Christianity
Church of Bible Understanding Stewart Trail
Church of Satan
Church Universal and Triumphant Elizabeth Clare Prophet
City Councils
Confucianism
Conservative
Crossfit
Eckankar
Elan Vital Divine Light Mission Guru Maharaja Ji Prem Rawat
Emin
Emissaries of Divine Light
Episcopal
Evangelical
Falun Gong Li Hongzhi
Fiat Lux
Folk religion
Freemasons
Fundamentalist Latter-Day Saints
Girl Scouts
Graduate School
Greater Apostolic Faith
Herbalife
Hinduism
House of Yahweh Bill Hawkins
Humanist/Atheist
International Churches of Christ (disciplining ministries)
ISIS
Iskcon – Krishna
Islam
Judaism
Kabbalah Centre Berg
Kashi Ashram Joyce Green
Kiwanis club
Ku Klux Klan
Landmark (former Est)
Latter-Day Saints
Legionaries of Christ
Local Church Ministry Watchman Nee
Love Family Love Israel Paul Erdman
Lutheran
Lyndon LaRouche
Mahikari Sukyo Mahikari
Marxist
Medical School Training
Mek
Methodist
Military Training
Moon Organization
MSIA John-Roger Hinkins
Multi-level-Marketing MLM
Nation of Islam
National Labor Federation (NATFED) Gino Parente
Nazism
New Acropolis
New Age
Nuwabian Nation Dwight York
Nxivm: Keith Raniere
Opus Dei