1. What is your age?
Answer: ________
2. What is your religion?
Answer: ________
3. If you are Christian, what is your denomination?
4. What City/Town have spent most of your life in?
Answer: ________
5. Are your parents alive?
Answer: ________
6. What is your occupation?
Answer: ________
7. What is your highest level of education?
Answer: ________
8. If you’ve attended a university, what was your course of study?
Answer: ________
9. What is/was your mother’s occupation?
Answer: ________
10. What is/was your father’s occupation?
Answer: ________
11.Which languages do you speak proficiently other than English?
Answer: ________
12. What is your current city of residence?
Answer: ________
13. Which section of the city do you currently reside in?
Answer: ________
14. How many siblings do you have?
Answer: ________
15. You were the _______ (1st, 2nd, 3rd …etc) born in the family, out of ______ children.
Answer: ________ , _________
16. Gender of all siblings: ____ boys, _____ girls.
17. What is your mother’s religion?
Answer: ________
18. What is your father’s religion?
Answer: ________
19. How are relations between immediate family members and yourself?
Please check the appropriate answer.
__ Good
__ Very Good
__ Excellent
20. Do you tend to make decisions…
__ In total solitude
__ With the advice of a few people
__ With the advice of moderate numbers of people
__ With the advice of large numbers of people
21. Arranged marriages are…
__ No longer appropriate
__ Were never appropriate
__ A good idea if the decision is made by consensus, including the thoughts/feelings of the daughter/son as a major consideration, and while the daughter/son is at least a nominal adult.
__ A great idea if the decision is made by consensus, including the thoughts/feelings of the daughter/son as a major consideration, and while the daughter/son is at least a nominal adult.
22. Success in marriage is most likely the result of…
__ Compatible temperaments.
__ Ongoing effort, genuine attempts to understand the others perspective negation and compromise over time
__ Prayer
23. How is your eyesight?
__ Excellent
__ Good
__ Fair
24. Do you wear spectacles?
__ Yes
__ No
25. What do you do when you are not working?
Answer: _____________________________
26. Is the wife’s legitimate role in decision making to provide input and to advise, with the husband making the final decision? Why?
Answer: _____________________________
27. Should the wife and husband divide responsibility for decision making equally, attempting to arrive at a consensus? Why?
Answer: _____________________________
28. Should the husband make all the major decisions, with the wife making the minor ones, as has been done traditionally throughout the world? Why?
Answer: _____________________________
29. Which of the following values to you hold most dearly?
__ Being cooperative, trying to help achieve harmony in most situations
__ Being strong in order to be in a position to help others
__ Being just, even everyone disagrees with you
30. When entering an unfamiliar situation, your first question is…
__ What are the rules?
__ Don’t worry, we’ll get through this.
__ I cannot really affect a situation positively, unless I am in a position of power.
31. What are the main duties of a husband to his wife?
Answer: ________
32. What are the main duties of a wife to her husband?
Answer: ________
33. What are the duties of a parent to their children?
Answer: _____________________________
34. Which best describes you?
__ Communist
__ Socialist
__ Capitalist
35. Do you get angry?
__ Occasionally
__ Rarely
__ Almost Never
__ Never
36. Do you prefer…
__ Action
__ Contemplation
__ Both action and contemplation
37. Do you have…
__ Very short hair
__ Short hair
__ Mid-length hair
__ Long hair
38. How many times a week do you wash your hair?
Answer: ____
39. Would you describe yourself as….
__ Very serious
__ Serious
__ Not very serious
40. Are you of _____ intelligence?
__ Average
__ Above Average
__ Exceptional
41. Are you of ______ competence?
__ Average
__ Above Average
__ Exceptional
42. How would you describe you overall health?
__ Average
__ Good
__ Very good
__ Exceptional
43. How many hours per week do you work?
Answer: ______
44. Do you smoke?
Answer: _____
45. What is your build?
__ Strong and Sturdy
__ Thin
__ Medium
46. How deeply do you sleep?
__ Lightly
__ Of moderate depth
__ Deeply
47. Do you make decisions…
__ Very quickly
__ Quickly
__ After a reasonable amount of time
__ Slowly
48. Do you have…
__ Many, many friends
__ Many friends
__ A few close friends
49. If you could eat anything without physiological consequences, or guilt, what would your dietary preferences be?
__ Sweets/Candies
__ Meat/Protien
__ Rice
__ Vegtables/Fruits
50. What is the main problem with people today?
Answer: ________________________________
51. Which three characteristics would those who know you best attribute to you?
Answer: ________________________________
52. Would you describe your tolerance for discomfort/pain as…
__ Above Average
__ Very high
__ Exceptional
53. Would you describe you patience as…
__ Above Average
__ Very high
__ Exceptional
54. Is your weight?
__ Above Average
__ Average
__ Below Average
55. Are you thin?
Answer: ___
56 Are you very thin?
Answer: ___
57. Are you physically very sturdy/strong?
Answer: __
58. The first obligation is to…
__ Oneself
__ One’s family and friends
__ Society
59. The second obligation is to…
__ Oneself
__ One’s family and friends
__ Society
60. Would you describe yourself as a fanatic?
Answer: ____
61. What was your rank in your class during the last two years of formal education you had? How many students were in the class.
Answer: _____ , ______
62. What is the most important thing in life?
__ To do God’s will
__ To be morally upstanding
__ To do all things in moderation and follow the middle way
__ To make full use of the gifts that God has given us
__ To live a life full of people and share with those people day to day
63. How is your mother’s health? What, if any, are the problems?
Answer: __________________________________________
64. How is your father’s health? What, if any, are the problems?
Answer: __________________________________________
65. How are your siblings health? What, if any are the problems?
Answer: __________________________________________
66. What is your favorite beverage?
__ Soft drinks
__ Water
__ Coffee
__ Tea
67. Describe your dwelling. How big is it? How many people live in it?
Answer: ____________________________________________
68. What are the three biggest obstacles that you face every day?
Answer: ____________________________________________
69. How many non-Indic languages do you speak proficiently? What are they?
Answer: ____________________________________________
70. What are your three greatest pleasures in life?
Answer: ____________________________________________
71. Compared to others, is the skin at you extremities (hands, face, etc.)?
(Check all that apply)
__ Dry but beautiful
__ Moist
__ Clear
72. When you wake up, how do you usually feel?
__ Slow to get up, but accepting that one has to get up
__ Eager to get up
__ Very eager to get up
73. When you get up in the morning, how do you usually feel?
__ Somewhat rested
__ Moderately rested
__ Well rested
__ Very well rested
__ Very very well rested
74. Do you get sad?
__ Often
__ Occasionally
__ Rarely
__ Never
75. Sex before marriage is best viewed as….
__ A serious sin
__ A substantial sin
__ Something wicked
__ Inappropriate and problematic
__ Appropriate as long as the two parties are in a committed relationship
76. This is question 76?
__ Answer 1
__ Answer 2
77. This is question 77?
