Instructions:

The following questions ask whether different events have happened to you in the last 10 years. Please indicate “yes” or “no” for each.




In the last 10 years, have you ever…





1

a

__Yes __No

Rented a movie


b

__Yes __No

Returned a movie you rented without having watched it at all

2

a

__Yes __No

Bought new clothes or shoes


b

__Yes __No

Bought new clothes or shoes you never wore

3

a

__Yes __No

Gone shopping for food or groceries


b

__Yes __No

Threw out food or groceries you had bought, because they went bad

4

a

__Yes __No

Done your own laundry


b

__Yes __No

Ruined your clothes because you didn't follow the laundry instructions on the label

5

a

__Yes __No

Been enrolled in any kind of school


b

__Yes __No

Been suspended from school for at least one day for any reason

6

a

__Yes __No

Had any kind of job


b

__Yes __No

Quit a job after a week

7

a

__Yes __No

Had a driver’s license


b

__Yes __No

Had your driver's license taken away from you by the police

8

a

__Yes __No

Driven a car


b

__Yes __No

Been accused of causing a car accident while driving


c

__Yes __No

Gotten more than 5 parking tickets


d

__Yes __No

Gotten more than 5 speeding tickets


e

__Yes __No

Gotten lost or gone the wrong way for more than 10 minutes while driving


f

__Yes __No

Locked your keys in the car

9

a

__Yes __No

Bought any kind of car


b

__Yes __No

Had to spend at least $500 to fix a car you had owned for less than half a year

10

a

__Yes __No

Taken a trip by airplane


b

__Yes __No

Missed a flight

11

a

__Yes __No

Taken the train or the bus


b

__Yes __No

Taken the wrong train or bus

12

a

__Yes __No

Had any form of ID (driver’s license, passport, birth certificate)


b

__Yes __No

Had your ID replaced because you lost it

13

a

__Yes __No

Lived in a rented apartment or other rental property


b

__Yes __No

Been kicked out of an apartment or rental property before the lease ran out

14

a

__Yes __No

Carried a key to your home


b

__Yes __No

Had the key to your home replaced because you lost it


c

__Yes __No

Locked yourself out of your home

15

a

__Yes __No

Been responsible for electricity, cable, gas or water payments


b

__Yes __No

Had your electricity, cable, gas or water shut off because you didn't pay on time

16

a

__Yes __No

Been responsible for a mortgage or loan


b

__Yes __No

Foreclosed a mortgage or loan

17

a

__Yes __No

Been responsible for rent or mortgage payments


b

__Yes __No

Paid a rent or mortgage payment at least 2 weeks too late







In the last 10 years, have you ever…


18

a

__Yes __No

Used checks


b

__Yes __No

Had a check bounce

19

a

__Yes __No

Had a credit card


b

__Yes __No

Had more than $5000 in credit card debt

20

a

__Yes __No

Invested in the stock market


b

__Yes __No

Lost more than $1000 on a stock-market investment

21

a

__Yes __No

Been to a bar, restaurant, or hotel


b

__Yes __No

Been kicked out of a bar, restaurant, or hotel by someone who works there

22

a

__Yes __No

Loaned more than $50 to someone


b

__Yes __No

Loaned more than $50 to someone and never got it back

23

a

__Yes __No

Had a romantic relationship that lasted for at least 1 year


b

__Yes __No

Cheated on your romantic partner of 1 year by having sex with someone else

24

a

__Yes __No

Been married


b

__Yes __No

Been divorced

25

a

__Yes __No

Had sex


b

__Yes __No

Been diagnosed with an STD


c

__Yes __No

Had an unplanned pregnancy (or got someone pregnant, unplanned)

26

a

__Yes __No

Had sex with a condom


b

__Yes __No

Had a condom break, tear, or slip off

27

a

__Yes __No

Had an alcoholic drink


b

__Yes __No

Consumed so much alcohol you vomited


c

__Yes __No

Received a DUI for drunk driving

28

a

__Yes __No

Been out in the sun


b

__Yes __No

Got blisters from sun burn

29

a

__Yes __No

Been in a jail cell overnight for any reason

30

a

__Yes __No

Been in a public fight or screaming argument

31

a

__Yes __No

Declared bankruptcy

32

a

__Yes __No

Forgotten a birthday of someone close to you and did not realize until the next day or later.

33

a

__Yes __No

Been diagnosed with type 2 diabetes

34

a

__Yes __No

Broke a bone because you fell, slipped, or misstepped