| 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. |