| Read the life events listed below and if any of these have occurred in the last two years check the box. |
| Marriage and Relationship |
| Divorce | | 1. |
| Gaining a new family member (birth, adoption, older adult moving in, etc.) | | 2. |
| Major change in the number of arguments with spouse (either a lot more or a lot less than usual regarding child rearing, personal habits, etc.) | | 3. |
| Marital reconciliation with mate | | 4. |
| Marital Separation from mate | | 5. |
| Marriage | | 6. |
| Pregnancy | | 7. |
| Sexual Difficulties | | 8. |
| Son or daughter leaving home (marriage, attending college, joined military) | | 9. |
| Trouble with in-laws | | 10. |
| Finance |
| Foreclosure on a mortgage or loan | | 11. |
| Taking on a loan (for car, tv, freezer, etc.) | | 12. |
| Taking on a mortgage (for home, business, etc.) | | 13. |
| Work Related |
| Being fired at work | | 14. |
| Changing to a different line of work | | 15. |
| Major business readjustment | | 16. |
| Major change in financial state (a lot worse or better off than usual) | | 17. |
| Major change in responsibilities at work (promotion, demotion, etc.) | | 18. |
| Major changes in working hours or conditions | | 19. |
| Retirement from work | | 20. |
| Spouse beginning or ceasing work outside the home | | 21. |
| Trouble with the boss | | 22. |
| Change in Lifestyle |
| Beginning or ceasing formal schooling | | 23. |
| Changes in residence | | 24. |
| Changing to a new school | | 25. |
| Major change in church or temple activity (a lot more or less than usual) | | 26. |
| Major change in eating habits (a lot more or less food intake, or very different meal hours or surroundings) | | 27. |
| Major change in living condition (new home, remodelling, deterioration of neighbourhood or home etc.) | | 28. |
| Major change in number of family get-togethers | | 29. |
| Major change in sleeping habits (a lot more or a lot less than usual) | | 30. |
| Major change in social activities (clubs,movies,visiting,etc.) | | 31. |
| Major change in usual type and/or amount of recreation | | 32. |
| Major holidays | | 33. |
| Major�Change�in�the�health/behavior�of�a�family�member | | 34. |
| Outstanding personal achievement | | 35. |
| Revision of personal habits (dress manners, associations, quitting smoking) | | 36. |
| Vacation | | 37. |
| Violations and Law |
| Detention in jail or other institution | | 38. |
| Minor violations of the law (traffic tickets, jaywalking, disturbing the peace, etc.) | | 39. |
| Death & Injury |
| Death of a close family member | | 40. |
| Death of a close friend | | 41. |
| Death of spouse | | 42. |
| Major personal injury or illness | | 43. |
| * Required | |
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