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* 1. The demographics below are needed to represent you and your message to the Vatican statistically and anonymously in aggregate form. Depending on the volume of responses from your diocese, we may send data to your local bishop.

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* 3. Please check the topics that you feel need reform in the Church.

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* 4. My present circumstance is best described as (check as many as fit your situation):

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* 5. I believe the church has a responsibility to educate Catholics to assume more responsibility for all aspects of life rather than focus exclusively on birth control and abortion.

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* 6. In his inaugural Mass homily, Pope Francis called on everyone to be “protectors of creation, protectors of God’s plan inscribed in nature, protectors of one another and of the environment." What world concerns would you suggest that the Church adopt to emphasize our responsibilities as co-creators of life on earth?

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* 7. Pope Paul VI's Humanae Vitae declared that "every matrimonial act must be open to the transmission of life." Indicate whether you agree or disagree with this teaching.

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* 8. If you do not agree with Paul VI's encyclical, what are the life-giving benefits of the marital relationship - beyond procreation - that you would suggest as alternatives to Church teaching.

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* 9. Women have proven in contemporary society that they are gifted and deserve consideration based upon their skills. However, in the Roman Catholic Church, women remain second class citizens.

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* 10. Respecting our baptismal rights as equal members of the Body of Christ and in acknowledgement of the societal changes in the status of women, what changes do you suggest need to be made in Church policies?

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* 11. In support of official Church's teaching regarding primacy of conscience, I believe that decisions regarding the size and spacing of families should be left up to the discernment of the couple.

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* 12. Would you share your personal story, whether positive or negative, regarding your own situation of striving to live in a family while keeping in mind the Church's present teaching that all acts of love must remain open to creating life.

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* 13. If you have a comment not covered in this survey that you would like to add, please do so.

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