Relationship Survey
Relationship Survey
Gender
Male
Female
Age
17-26
27-36
37-46
47-56
57-66
Other
Ethnicity
African American
Asian
Caucasian
Latino
Native American
Other
Relationship Status
Single
Married
Separated
Divorced
Domestic Partners
Widow
Other
Identify and explain at least two behaviors your significant other has displayed that you would alter.
In what manner have you shown your significant other that you care for him/her?
Explain how you learned to love.
How often do you watch television?
Very much
Often
Average
Not often
Not at all
What are the major differences between men and women?
Men
Women
Strengths
Weaknesses
Explain why men and women can or cannot be friends.
Describe how love has or has not met your expectations.
How important is sex to a good relationship?
Extremely
Somewhat important
Neutral
Somewhat unimportant
Unimportant
How would you rate the communication between you and your significant other?
Really good
Good
Average
Needs work
Not good at all
What roles do friends play in relationships?
How many successful relationships have you witnessed? Please identify those traits that make them successful.
If you could read minds, how would society describe the way in which men and women relate?
How often do you tell your significant other that you love him/her?
Very much
Often
Sometimes
Rarely
Not at all
What prevents couples from reaching their maximum potential?
What is the importance of forgiveness?
Place a check in one box only per row for each catagory.
What gender is more dominant when it comes to being:
Men
Women
Both
Intimate
Manipulative
Responsible
Sexual
Logical
Aggravating
Caring
Compromising
Friendly
Suspicious
Leader
Disrespectful
Confrontational
Reassuring
Emotional
Explain the role of parents in relationships.
What role does religion play in relationships?
How do expectations of raising a family affect your relationship?
Please provide a few recommendations for couples.
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All responses are submitted anonymously and will be used in a forthcomming book. Word to the wise, "Love may keep us together or tear us apart when unsure about why we do what we do!"