Thank you for taking this survey.

Please remember to answer these questions as honestly as possible. Your answers will be used to help us know more about how those in our community are experiencing and dealing with loneliness. This is a blind survey, no information is collected about you other than your answers to the questions.

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* 1. Have you ever been or felt lonely?

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* 2. When or what situations brought on the feeling of loneliness?

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* 3. Do you know why you felt lonely at these times?

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* 4. Did you do something or think something to try to alleviate your feeling of loneliness?

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* 5. Please share what you did to try to alleviate your feeling of loneliness.

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* 6. How often do you feel that you lack companionship? Your answers to questions 6-8 will provide you with a number on a scale of loneliness. The scale was created by scientists and researchers at the University of California, Los Angeles (UCLA)

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* 7. How often do you feel left out?

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* 8. How often do you feel isolated from others? Your score will appear on the next page. If you have scored between 6-9 you are considered to be lonely at this time. If your score is 3-5 you are considered to not be lonely at this time.

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