Select any event(s) that you may have been involved in the past 12 months. When you are finished, click the button at the bottom labeled “Submit”.

Death of spouse
Divorce
Separation
Jail term
Death of a close family member
Personal injury or illness
Marriage
Fired from job
Reconciliation
Retirement
Change of health of a family member
Pregnancy
Difference in frequency of sexual relationships
New family member
Business readjustment
Change in financial state
Death of a close friend
Change in line of work
Change in number of arguments with spouse
Foreclosed mortgage or loan
Change in work responsibility
Son or daughter leaving home
In-law trouble
Outstanding achievement
Spouse beginning or ending work
Beginning or ending school
Change in living conditions
Revision in personal habits
Trouble with boss
Change in work hours or conditions
Change in residence
Change in school
Change in recreation
Change in church activities
Change in social activities
Mortgage or loan less than $10,000
Change of sleep habits
Change in number of family get-togethers
Change in eating habits
Vacation
Christmas
Minor violations of the law