X hits on this document

231 views

0 shares

0 downloads

0 comments

83 / 89

APPENDIX C Screening Questions for Stepcouples

You are: female ____ male ____ Current age of each partner: self partner ____ Educational level: self ____ partner ____ Household income level: $0-$19,999 ___ $40,000 – $59,000 ___ $60,000 – $79,999 ___ $20,000 – $39,999 ___ ___ $80,000 - $99,999

___

$100,000+

___

Current State of residency: _______________ How long have you been legally married or cohabiting? If cohabiting, do you plan to marry? Yes ____ No ____

______

Length of current relationship, (include total time including dating, cohabitation,

marriage, if applicable): ____________

Have you been married or in a committed relationship before? Yes ____ No ____ Number of prior marriages: ____ Number of prior committed relationships ____ Please state each child’s first name only if you feel comfortable doing so. Indicate age, gender, the residency or visitation arrangement of all stepchildren, including those who are now adults: (for example, 8 yrs., female, lives in home 50% of time; or 18 yrs., male, away at college, lives with us during school holidays).

(Name)

Age

Sex

Residency/Visit. Arrangement

Your Children:

Partner’s Children:

Do you have a child/children together (biological or adopted during your current relationship )?

If so:

(Name)

Age

Sex

Residency/Visit. Arrangement

APPENDIX C - CONTINUED

Please consider the issue most difficult for you as a couple – label it using five words or less:

__________________________________________________________

On a scale of 1 to 10, please rate how much of a threat to your relationship you believe the above issue to be:

________________________________________________________ 1 2 3 4 5 6 7 8 9 10

(not a threat to relationship)

(very threatening to relationship)

78

Document info
Document views231
Page views231
Page last viewedWed Dec 07 18:37:43 UTC 2016
Pages89
Paragraphs950
Words38315

Comments