Dealing with the "Ex" Survey

 
Instructions:  Fill in your answers to each of the items as indicated.  You may leave the items marked "(optional)" blank, but all other items require an answer.

Type your name (optional):

Type your email address (optional):

Select your gender:

Select your age:

Select your spouse's gender:

Select your spouse's age:

Select the total number of years you have been in your present relationship:

Select the total number of years you have been living together:

Select the total number of years you have been married: 

~~~

Total number of kids in your stepfamily: 

.

Total number of "full-time" kids living in your home now:

.

Total number of "part-time" kids living in your home now:

.

Total number of "Her Kids" living in your home now: 

.

Total number of "His Kids" living in your home now: 

.

Total number of "Our Kids" living in your home now: 

~~~ 

Select the current ages of all "full-time" and "part-time" kids living in the home (Check all that apply. Don't worry if two or more kids are the same age. In this survey we are primarily interested in the age levels present in the home.):

less than 1 yr old 1 year old 2 years old
3 years old 4 years old 5 years old
6 years old 7 years old 8 years old
9 years old 10 years old 11 years old
12 years old 13 years old 14 years old
15 years old 16 years old 17 years old
18 years old 19 years old 20 years old
21 years old 22 years old 23 years old
24 years old 25 years old over 25 yrs old

 ~~~

How satisfied are you with your current circumstances as a stepfamily?

.

How satisfied are you with your current circumstances as a couple?

.

Which of the following do you feel is the "number one" problem for you as a couple, or for the family right now?

.

Which of the following do you feel is the "number two" problem for you as a couple, or for the family right now?

.

Which of the following do you feel is the "number three" problem for you as a couple, or for the family right now?

.

 ~~~

Have you and/or your spouse ever taken a course on stepfamilies?

.

If so, was it helpful?

.

Have you and/or your spouse ever seen a counsellor regarding concerns with your present stepfamily?

.

If so, was it helpful?

~~~ 

In as much detail as you feel is necessary, please describe, by typing in the box below, the kinds of difficulties you were having, or are currently having with the "Ex(s)". Feel free to use examples if they will help.

 

In the box below, explain how you solved this/these problem(s). (If you haven't solved it/them yet, describe the actions that you have undertaken that seem to have been helpful.)

 

That's it!

Thank you for your time and effort. Now, just click on the "submit" button (below) once to submit your answers and claim your gift.

All rights reserved. The reproduction, use, distribution or storage or of this work, in whole or in part, by any and all means, without the express written permission of the author, is strictly prohibited.

 

Stepfamily Foundation of Alberta