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Singles Check In
1.
What is your age?
18-24
25-29
30s
40s
50s
60s
70s+
2.
Please indicate your gender
Male
Female
Prefer not to answer
3.
Which of the following best describes your relationship status?
Single (never married)
Single (divorced)
Single (widowed)
Section 1 of 3 - Personal Wellness: Rate the following dimensions of your life.
4.
Spiritual Life
7 - Excellent
6
5
4 - Okay
3
2
1 - Struggling
5.
Friendships
7 - Excellent
6
5
4 - Okay
3
2
1 - Struggling
6.
Self-Control
7 - Excellent
6
5
4 - Okay
3
2
1 - Struggling
7.
Physical Health and Fitness
7 - Excellent
6
5
4 - Okay
3
2
1 - Struggling
8.
Emotional Wellness
7 - Excellent
6
5
4 - Okay
3
2
1 - Struggling
9.
Financial Stability
7 - Excellent
6
5
4 - Okay
3
2
1 - Struggling
Section 2 of 3 - Rate yourself on the following relationship skills
10.
Communication
7 - Excellent
6
5
4 - Okay
3
2
1 - Struggling
11.
Empathy/Listening
7 - Excellent
6
5
4 - Okay
3
2
1 - Struggling
12.
Conflict Resolution
7 - Excellent
6
5
4 - Okay
3
2
1 - Struggling
13.
Forgiveness
7 - Excellent
6
5
4 - Okay
3
2
1 - Struggling
14.
Meeting new people
7 - Excellent
6
5
4 - Okay
3
2
1 - Struggling
Section 3 of 3 - Rate your level of agreement with the following statements
15.
My church provides a community where I feel comfortable and included.
Agree strongly
Agree
Agree somewhat
Neutral
Disagree somewhat
Disagree
Disagree strongly
Not applicable - I do not attend church
16.
I sometimes feel weighed down by “baggage” from the past.
Agree strongly
Agree
Agree somewhat
Neutral
Disagree somewhat
Disagree
Disagree strongly
17.
I desire to get married in the future.
Agree strongly
Agree
Agree somewhat
Neutral
Disagree somewhat
Disagree
Disagree strongly
18.
All in all, how satisfied are you with your closest relationships? Are you…
Completely satisfied
Very satisfied
Somewhat satisfied
Not very satisfied
Not at all satisfied
Current Progress,
0 of 18 answered
