Your Name (optional):

1. Are you a stepparent? Stepparent Status Yes, I'm a Stepmother Yes, I'm a Stepfather No, I'm not a Stepparent  

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2. Is this your first stepfamily union? Select Yes No N/A

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3. Are you currently living in a stepfamily setting?  Select Yes No Other - (provide details in Question 4.) N/A  

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4. Your current relationship status: Select Married Common Law Separated Divorced Bereaved Other N/A

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5. Select Your Age 20 or less 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 Over 70  

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6. Please type your current occupation into this box.                                         

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7. Select Your Partner's Age N/A 20 or less 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 Over 70  

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8. Your Partner's Occupation? 

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9. Have you or your partner ever taken a course (or courses) on stepfamilies? Select the best answer No, neither of us has Only I have Only my partner has Yes, we both have N/A

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9b. If yes, were any of these courses provided by the Stepfamily Foundation of Alberta? Select Yes No N/A

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10.  Have you or your partner ever seen a counsellor regarding stepfamily issues? Select the best answer No, neither of us has Only I have Only my partner has Yes, we both have N/A

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10b. If yes, was any of the counselling provided by the Stepfamily Foundation of Alberta? Select Yes No N/A

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11a. The total number of years you have been involved in your current (or most recent) relationship:

                    Select Less than 1 year 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years 10 years 11 years 12 years 13 years 14 years 15 years 16 years 17 years 18 years 19 years 20 years 20 to 25 years 25 to 30 years 30 to 35 years 35 to 40 years 40 to 45 years 45 to 50 years Over 50 years N/A [Include all the years you were dating.]

            11b. Total number of years you have been living with your current (or most recent) partner: 

                    Select Never have lived together Less than 1 year 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years 10 years 11 years 12 years 13 years 14 years 15 years 16 years 17 years 18 years 19 years 20 years 20 to 25 years 25 to 30 years 30 to 35 years 35 to 40 years 40 to 45 years 45 to 50 years Over 50 years N/A

            11c. Total number of years you have been married to your current (or most recent) partner:  

                    Select Not Married Less than 1 year 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years 10 years 11 years 12 years 13 years 14 years 15 years 16 years 17 years 18 years 19 years 20 years 20 to 25 years 25 to 30 years 30 to 35 years 35 to 40 years 40 to 45 years 45 to 50 years Over 50 years N/A

            11d. Total number of years you have been separated from your current (or most recent) partner:

                    Select Not Separated Less than 1 year 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years 10 years 11 years 12 years 13 years 14 years 15 years 16 years 17 years 18 years 19 years 20 years 20 to 25 years 25 to 30 years 30 to 35 years 35 to 40 years 40 to 45 years 45 to 50 years Over 50 years N/A

            11e. Total number of years you have been divorced from your most recent partner:

                    Select Not Divorced Less than 1 year 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years 10 years 11 years 12 years 13 years 14 years 15 years 16 years 17 years 18 years 19 years 20 years 20 to 25 years 25 to 30 years 30 to 35 years 35 to 40 years 40 to 45 years 45 to 50 years Over 50 years N/A

            11f. Total number of years you have been bereaved by your most recent partner:  

                    Select Not Bereaved Less than 1 year 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years 10 years 11 years 12 years 13 years 14 years 15 years 16 years 17 years 18 years 19 years 20 years 20 to 25 years 25 to 30 years 30 to 35 years 35 to 40 years 40 to 45 years 45 to 50 years Over 50 years N/A

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