Site Home Site Home
Medical Services
Support Services
Contact Us
Donor News
Events

Relationship Survey

Section 3:  Planning for a Permanent Relationship


Part One: Evaluation

  1. In Section One you expressed three goals for the future. Do you feel that your present life-style is bringing you closer to or further away from these goals?      Closer   Further



  2. How would getting a sexually transmitted disease affect your future goals?



  3. How would getting pregnant affect your future goals?



  4. How would the person you want to marry someday feel about your current relationships?



  5. Do you see areas in your life that need to change in order to reach your goals?      Yes   No



  6. What are they?
    1. _____________________________________


    2. _____________________________________


    3. _____________________________________



Part Two: Planning

  1. What steps can you take to begin these changes?
    1. _____________________________________


    2. _____________________________________


    3. _____________________________________


  2. How will these steps affect your current relationship?



  3. How will you feel if that happens?



  4. How will these steps affect your relationship with your parents?



  5. ...your relationship with your friends?



  6. ...your relationship with God?



  7. How would you feel about the change in these relationships?



  8. Who would agree and support you in taking these steps?
    1. _____________________________________


    2. _____________________________________


    3. _____________________________________



Go to Survey Section: 1  2  3  |   Survey Home  |  Printable Version of Entire Survey