When were you born?

Day (optional) - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   Month 01 - Jan 02 - Feb 03 - Mar 04 - Apr 05 - May 06 - Jun 07 - Jul 08 - Aug 09 - Sep 10 - Oct 11 - Nov 12 - Dec   Year Before 1930 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

Where did you grow up (go to high school)?
            Grew up in Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware Florida Hawai'i Georgia Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Massachusetts Maryland Michigan Minnesota Missouri Mississippi Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island Tennessee Texas South Carolina South Dakota Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Dist of Columb. Puerto Rico Canada United Kingdom Australia New Zealand Mexico South America Europe Asia Africa Pacific Other     (Non-US Areas at End of List)

Sex
            Male   Female

Ethnicity:
            Decline to State European Mid East Black Asian Latino Native Amer Pacific Island

Education
            Elementary School High School College Masters Degree Doctoral Degree

How many Brothers and Sisters did you have (who survived infancy)?
            None      One      Two     Three      Four or More    

How many children have you had or do you plan to have?
            None      One      Two     Three      Four or More    

In relation to those who survived infancy, which best describes when were you born?
            First     Second     Middle Group     Next to Last     Last    

As to the issues of spirituality in your life, how would you describe their importance?
            Not at All     Minimally     Somewhat     Very     Most    

How often do you think about issues of the meaning of or the origins of life?
            Never     Monthly     Weekly     Daily     Hourly

Do you think humans have a soul (an existence outside of their physical bodies)?
            No     Doubtful     Mixed Feelings      Pretty Certain      Yes

Do you think that the soul exists before the person was born?
             No     Doubtful     Mixed Feelings      Pretty Certain      Yes

Do you think that the soul exists after the person dies?
             No     Doubtful     Mixed Feelings      Pretty Certain      Yes

Do you think that a person is either rewarded or punished after death?
             No     Doubtful     Mixed Feelings      Pretty Certain      Yes

Do you believe in an eternal being, force or god?
             No     Doubtful     Mixed Feelings      Pretty Certain      Yes

Do you believe that such eternal being, force or god is sentient?
             No     Doubtful     Mixed Feelings      Pretty Certain      Yes

Do you believe people and god look alike?
             No     Doubtful     Mixed Feelings      Pretty Certain      Yes

How often do you think about your own death?
            Never     Yearly     Monthly     Weekly     Daily

When you to think about it, what characterizes you thoughts most?
            Fear     Concern     Curiosity     Hopefulness     Joy

How responsible do you feel you are for behaving well in life and preparing for death?
            Not at all      Very little     Somewhat     Mostly     Totally

Independent of law or mores, how important is it for you to protect the lives of others?
            Not at all     Minimally     Somewhat     Very     Most

Independent of social and family pressure, how important is it for you to have children?
             Not at all     Minimally     Somewhat     Very     Most

Do you believe in Extra Sensory Perception (ESP)?
            No     Doubtful     Mixed Feelings      Pretty Certain      Yes

Have you ever experienced ESP or related phenomena?
           Never     Once     A few times     Yearly     Weekly

If you saw the movie “Sixth Sense”, what best characterizes your reaction?
           Disdain     Derision     Amusement     Absorption     Catharsis

Do you believe in the presence of ghosts or the spirits of the dead?
            No     Doubtful     Mixed Feelings      Pretty Certain      Yes

Which best describes the part of your life that you have attended religious services regularly?
           None     Quarter     Half     Three Quarters     Always           

Which of the following most accurately describes the religion which you practiced the most?
           Mainstream Protestant     Evangelical     Roman Catholic     Jewish     Other

How often do you read or listen to material relating to spirituality or religion?
          Never     Yearly     Monthly     Weekly     Daily

What best characterizes how you feel when others speak of their own spirituality or religion?
           Anger     Disdain    No Reaction     Interested     Positive

If you feel responsible for others coming to accept and practice your views on spirituality or religion, who is included?
           No one     Immediate Family     Friends     Acquaintances      Everyone

What level of this responsibility do you feel?
           None     Very Little      Medium     High     Total

What is the place in your life for your feelings about spiritual issues?
           None     Low     Medium     Central     Vital