Background Questionnaire for Diaconate Aspirants and Wives

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1 Background Questionnaire for Diaconate Aspirants and Wives After you submit this form, click on "Home" and then my website link to return to my website to complete more forms. General Information Date [Required] Name [Required] Address [Required] Telephone [Required] Gender [Required] [ ] Male [ ] Female Birthdate [Required] Childhood History Where were you born? [Required] What is your earliest childhood memory? How would you describe yourself as a child? As a child what kind of bad feelings did you have and when? What did your mother hope you'd be as an adult? What did your father hope you'd be as an adult? Page 1 of 11 Background Questionnaire for Diaconate Aspirants and Wives

2 Was it easy or hard for you to make friends as a child? Explain. What people have you felt close to in your life? Did you live in one place or did you move about? Please describe your reactions to the moves. Did you play with: [ ] Both boys and girls [ ] Only boys [ ] Only girls What were your favorite types of play or recreation as you were growing up? What were your favorite pastimes? What did your mother say when you did something wrong or disappoint her? What did your father say when you did something wrong or disappoint him? What nicknames did people call you? What do the names mean? What was your mother's favorite saying? Page 2 of 11 Background Questionnaire for Diaconate Aspirants and Wives

3 What was your father's favorite saying? How did you think you would turn out? Have you tried to get help previously? [ ] Yes [ ] No School History What grade school(s) and middle schools(s) did you attend? What high school(s) did you attend? What is the highest level of education you completed? [ ] Still in School [ ] Did not finish high school [ ] High School [ ] Some College [ ] College Undergraduate Degree [ ] College Graduate Degree(s) What year was that and what was your age? What year did you finish high school and what was your age? What college degrees do you have? Did you go as far in school as you wanted to? If not, how far did you want to go? What kind of student were you? Page 3 of 11 Background Questionnaire for Diaconate Aspirants and Wives

4 Did you have any learning difficulties? If so, describe. What were your favorite subjects? Dating and Marriage How old were you when you began dating? How often did you date as a teenager? What did you like to do on a date? How did you learn about sex, when, and from whom? Are you: [ ] Never Married [ ] Married [ ] Separated [ ] Divorced [ ] Widowed If currently married, how long have you been married and what is his/her age? If currently married, what is his/her education and occupation? If you have previous marriages, how many times have you been married; how long each time; and why you divorced. If so, were your marriages annulled? Does your current spouse have an illness or physical defect? If so, describe. Do you feel that your marriage needs work? If so, why and in what way? Page 4 of 11 Background Questionnaire for Diaconate Aspirants and Wives

5 What kind of person is your spouse? How long did you know him/her before you were married? What do you enjoy most about your marriage? What is most difficult about your marriage? Who handles the money? Any difficulty in this area? Are you satisifed with your sexual relationship? If not, explain. What are the names, ages, and gender of your children (note if any are step-children)? Do any of the children have illnesses or physical defects? Which child is easiest to get along with and why? Which child is most difficult and why? Page 5 of 11 Background Questionnaire for Diaconate Aspirants and Wives

6 Who disciplines the children - why and how? Work History What is your present job and how long have you been in this job? Did you choose the field you are in? [ ] Yes [ ] No List other previous jobs, how long, and why you left. How do people at your present work treat you? Describe any problems. Are you satisfied at your current job? If not, why not. Family History Are your parents living? [ ] Both living [ ] Only mother living [ ] Only father living [ ] Both deceased How old are your living parents and what is their health status? If parent(s) are deceased, when and at what ages and from what causes did death occur? Page 6 of 11 Background Questionnaire for Diaconate Aspirants and Wives

7 What is your father's education and occupation? What is your mother's education and occupation? What are the names, ages, and occupation of each of your siblings? Which of your siblings were you closest to as you grew up? Which sibling gave you the most trouble and why? What mental health issues have occurred in your family or relatives? What kind of person is/was your father? What kind of person is/was your mother? How did you get along with your parents? What do you remember most about your parents? How did your parents get along with each other? Page 7 of 11 Background Questionnaire for Diaconate Aspirants and Wives

8 What type of things did they argue about? How did they show affection to the children? How did they show affection to each other? What's the worst thing your mother ever did to you? What's the worst thing your mother ever said to you? What's the nicest thing your mother ever did for you? What's the nicest thing your mother ever said to you? What's the worst thing your father ever did to you? What's the worst thing your father ever said to you? Page 8 of 11 Background Questionnaire for Diaconate Aspirants and Wives

9 What's the nicest thing your father ever did for you? What's the nicest thing your father ever said to you? What outside activities did your family have? Personal History Describe any legal problems you have had. What is your main interest outside of work? What other hobbies and interest do you have? What clubs or organizations do you belong to? What parish are you a member of? What do you like most about yourself? Page 9 of 11 Background Questionnaire for Diaconate Aspirants and Wives

10 What do you like least about yourself? Do you ever feel that something might be wrong with you? If so, what? When you feel bad, what is the feeling you most often have? Have you ever had psychotherapy? If so, when. What aches, pains, or physical discomforts do you have? Have you ever been hospitalized? What serious illnesses and accidents have you had during your life? How often do you drink alcohol and how much? What drugs have you used and for what? What in life do you feel best about? What in life do you feel worst about? Page 10 of 11 Background Questionnaire for Diaconate Aspirants and Wives

11 What is your most unpleasant memory? What is your most pleasant memory? Page 11 of 11 Background Questionnaire for Diaconate Aspirants and Wives

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