1. Are you male or female?

Male
Female

2. Nationality
Pacific islander
Hispanic
Asian
Black American
White American
Other (please specify)

3. Age range:
16-21 years old
22-27 years old
28-33 years old
34 or older

4. Sexual orientation
Straight
Bi
Gay
Not sure

5. Are you currently in a relationship?

Yes
No

6. How much do you know about infatuation?

None

Alittle

Somewhat

Accurate

Alot

Choose from the

following

7. How much do you know about love in a relationship?

Somewhat

Accurate

Alot

Alittle

None

Married

Engaged

Divorced

widowed

Single

Choose from following

8. Relationship staus

Status

9. Do you believe in true love?

Yes
No
I don't know

10. When it comes to love, what quality do find most important to have..
Trust

Respect

Loyalty

Other

Choose from following

Other (please specify)

11. If you are married or not, on what ground would you most likely file for divorce?
Physical/or emotional abuse
Infidelity
Lack of communication/ or intimacy
Loss of interest
There is no such thing as divorce if both partners truly love each other

12. How important is sex in a relationship for you?

Very Important
Choose from following

Moderately important

Accurately important

Not important

13. Do you know some differences of infatuation vs. love?

Yes
No

14. Rank your relationship..

Happiness

Sadness

Contentedness

15. Do you have any other comments, questions, or concerns?