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Family Life Survey
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1.
What is your name?
(Required.)
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2.
Email Address
(Required.)
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3.
Phone number (Use the following format: 123-456-7890)
(Required.)
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4.
Are you now married, widowed, divorced, separated, or have you never been married?
(Required.)
Married
Widowed
Divorced
Separated
Never married
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5.
What topics around relationships interest you the most? (Select 5 topics)
(Required.)
Solving conflicts in relationships
Developing trust and commitment
Surviving heartbreak
Mars vs. Venus: Gender communication in a romantic relationship
Pre-marital relationships
Balancing love and religion
Dating as a Christian
Healing after disappointment
Love after children
The role of social media in relationships
Parenting 101: Raising and protecting our children
Managing divorce
Relating to young people
Other (please specify)
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6.
What activities interest you the most? (Select at least 3)
(Required.)
Movies
Bowling
Outdoor activities
Concerts
Live theater
Sporting events
Retreats
Book clubs
Skating
Other (please specify)
Current Progress,
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