OPIc Background Survey

Survey Questions:

1. Do you work? (Check one)
□ Full time
□ Part time
□ I don’t work (Proceed to question #5)

2. Where do you work?
□ Outside the home
□ At home
□ I don’t work

3. How many different companies have you worked for in your career?                     □ 1
□ 2-3
□ 4+
□ I don’t work

4. Are you a manager who supervises other people?                                                  □ Yes
□ No
□ I don’t work

5. Are you currently a student?                                                                                    □ Yes
□ No
□ I don’t work

6. Where do you live?                                                                                                  □ I am single and live alone in our house or apartment
□ I am married and live only with my spouse (and children if any) in a house or
apartment
□ I am single and live with my family members (parents, grandparents, siblings,
etc. ) in a house or apartment
□ I am married and live with my family members (parents, grandparents,
siblings, etc. ) in a house or apartment
□ I live with my friends or non-family members in a house or apartment
□ I live in my own in a boarding house
□ I share a room with others in a boarding house
□ I live in my own room in a students’ dormitory
□ I share a room with others in a students’ dormitory

7. What activities do you do? Check at least six.                                                         □ Go shopping
□ Restaurants
□ Movies
□ Clubs
□ Theater
□ Concerts
□ Museum
□ Parks
□ Camping
□ Professional Sports
□ Watch your children play sports.
□ Coach Sports
□ Play games by yourself
□ Play games with adults
□ Play games with children
□ Visit with friends/Visit friends
□ Study a language
□ Take a class
□ Teach a class
□ Help your children with school assignments
□ Do household chores
□ Do home improvement projects
□ Maintain your car
□ Go to the doctor/dentist
□ Go to church
□ Go to beauty salon/barber

8. What interests you or hobbies you enjoy? Check at least three.                             □ Watch TV or DVDs
□ Chat on the phone
□ Surf the internet
□ Read
□ Read to Children
□ Listen to music
□ Play a musical instrument
□ Sing alone
□ Sing with a group
□ Take dance class/lessons
□ Go out dancing
□ Write creatively (letters, short stories, poetry)
□ Draw/paint
□ Sew/embroider
□ Knit/crochet                                                                                                               □ Cook
□ Garden
□ Have pets

9. What sports or physical activities do you participate in?                                          □ Play basketball
□ Play baseball/softball
□ Play soccer
□ Play football
□ Play rugby
□ Play ice hockey
□ Play field hockey
□ Play cricket
□ Play golf
□ Play volleyball
□ Play tennis
□ Play badminton
□ Play table tennis
□ Swim
□ Bike
□ Scuba dive/snorkel
□ Waterski
□ Ice skate
□ Inline skate
□ Horseback ride
□ Job
□ Walk
□ Do yoga
□ Do pilates
□ Go hiking/trekking
□ Go fishing
□ Go biking
□ Go boating
□ Go to a health club
□ Exercise
□ I do not participate in sports or physical activities

10. What types of vacation travel do you do? Check at least one.                              □ Travel for Business Domestically
□ Travel for Business Internationally
□ Stay at home for vacation
□ Take vacation domestically
□ Take vacation internationally