|1.|| Describe the stress level of your job (examples: lay-offs expected, over-time, travel, seasonal workloads)|
|2.|| Describe your personal situations (married/single, children, other important family commitments, moving)|
|3.|| Do you consider yourself healthy? Yes No|
|4.|| Are you physically fit? Yes No|
|5.|| Are you experiencing financial difficulty or did you previously file for bankruptcy? Yes No|
|6.|| Have you been convicted of a felony? Yes No|
|7.|| Do you have a physical disability, which many require special arrangements on exam day? (Note: one student, whose eyesight was not correctible to 20/20, was allowed extra exam time and assistance with marking his answer sheet.) Yes No|
If yes, please describe your needs.