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J23. When you were a teenager, did you engage in(or experience)any of the following <br /> behaviors?(MARK ALL THAT APPLY) <br /> a. Using illegal drugs <br /> b. Getting in trouble with the law <br /> c. Having family conflicts <br /> d. Skipping classes <br /> e. Running away from home <br /> f. Fighting <br /> g. Dropping out of school <br /> h. Suspended or expelled from school <br /> i. Joining a gang <br /> j. Eating disorders(e.g., bulimia, anorexia) <br /> k. Suicide threats or attempts • <br /> I. Alcohol problems <br /> m. Phobias(fears) <br /> n. Anxiety problems <br /> o. Anger management problems <br /> p. None of the above <br /> ADULT RELATIONSHIPS <br /> Note: Your answers to the following questions may be verified by checks of records kept by police <br /> agencies, courts, and social service agencies, and by interviews with persons acquainted with <br /> you. If you deliberately give false or misleading answers,you may be disqualified. <br /> K1. What are your current living arrangements? (MARK ALL THAT APPLY.CONSIDER ADULTS ONLY.) <br /> a. Live alone(i.e.,with no other adults) <br /> b. Live with spouse <br /> c. Live with romantic partner other than spouse <br /> d. Live with parent(s) <br /> e. Live with adult roommate(s) <br /> f. Other(considering adults only) <br /> K2. What is your current marital status? <br /> a. Single <br /> b. Legally married <br /> c. Separated <br /> d. Divorced <br /> e. Widowed <br /> K3. How many times have you been married? <br /> a. Never <br /> b. 1 <br /> c. 2 <br /> d. 3 or more <br /> K4. Have you ever been separated, during your current marriage? <br /> a. No <br /> b. Yes <br /> • <br /> PSS/LEPS PLLC 92 <br />