Assessment Questionnaire Step 1 of 8 - Introduction 0% Your email will be required at the end of this assessment in order to send your results.Are you widowed?* Yes No What was your relationship to the person you are grieving?* Child Parent Sibling Friend How old are you now?*How old were you when your spouse or partner died?*How long ago was your spouse or partner’s death?*0-3 months (up to 89 days)3-6 months (90 to 179 days)6 -9 months (180 to 209 days)9 months to a year (210 to 364 days)1 year to 1 year 6 months1 year 6 months to 2 years2 years to 2 years and 6 months2 years and 6 months to 3 years3 years-up to 4 years4 years-up to 5 years5 years- up to 6 years6 years-up to 7 years7 years-up to 8 years8 years-up to 9 years9 years-up to 10 years10 years or moreI identify as* Female Male Transgender Gender nonconforming What is your race?*Please choose one or more White Hispanic Black or African-American Asian Native Hawaiian or other Pacific Islander American Indian or Alaska Native Which of these terms BEST describes your relationship?*(Your relationship with your deceased partner or spouse) Married Engaged In a committed relationship (not married and not engaged) Divorced How long was your marriage or relationship if not married?* 1-6 months 6 months to 1 year 1-2 year 2-3 years 3-4 years 4-5 years 5-6 years 6-7 years more than 7 years How long were you in a committed relationship?*(including any and all - dating + engaged + married) This is to capture your years together rather than restricting it to only the time you might have been legally married. 1-6 months 6 months to 1 year 1-2 years 2-3 years 3-4 years 4-5 years 5-6 years 6-7 years more than 7 years Are you currently married, remarried, or in another committed relationship?* Yes - Married or Remarried Yes - in a committed relationship (not remarried) No - neither remarried nor in a committed relationship Do you have children from your relationship with your spouse or partner?* Yes No Do you have children living at home?* Yes No How did your person die?* Sudden – within 24 hours of knowing there was a illness or issue (other than violence or suicide) Sudden - By violence (an act committed by another person, such as during a robbery) or suicide Less than 6 months after knowing there was an illness or issue More than 6 months after knowing there was an illness or issue Suicide Other Was your spouse or partner in the military?* Yes No Was your spouse or partner a first responder?* Yes No Agency, Identity and Sense of SelfI can face my problems head-on instead of ignoring them*Strongly disagreeDisagreeNeutralAgreeStrongly agreeI trust my gut*Strongly disagreeDisagreeNeutralAgreeStrongly agreeI can make a decision and follow through*Strongly disagreeDisagreeNeutralAgreeStrongly agreeI don't let others' expectations determine how I grieve*Strongly disagreeDisagreeNeutralAgreeStrongly agreeI feel confident I can learn how to do things my partner used to do*Strongly disagreeDisagreeNeutralAgreeStrongly agreeI have a strong sense of who I am, independent of my late partner*Strongly disagreeDisagreeNeutralAgreeStrongly agree Social SupportI have a fulfilling social life*Strongly disagreeDisagreeNeutralAgreeStrongly agreeI belong to a strong supportive community*Strongly disagreeDisagreeNeutralAgreeStrongly agreeI can find support for the things I need*Strongly disagreeDisagreeNeutralAgreeStrongly agreeI am comfortable asking for help when I need it*Strongly disagreeDisagreeNeutralAgreeStrongly agree Living in the MomentI can have fun in the moment*Strongly disagreeDisagreeNeutralAgreeStrongly agreeI can find humor in life*Strongly disagreeDisagreeNeutralAgreeStrongly agreeI find there are times when I can live in the moment*Strongly disagreeDisagreeNeutralAgreeStrongly agreeI laugh at least once every day*Strongly disagreeDisagreeNeutralAgreeStrongly agreeI can feel joy for others when something good happens to them*Strongly disagreeDisagreeNeutralAgreeStrongly agree Helping othersI am caring and compassionate*Strongly disagreeDisagreeNeutralAgreeStrongly agreeI use my experience to help others*Strongly disagreeDisagreeNeutralAgreeStrongly agreeI can sit with someone else in pain*Strongly disagreeDisagreeNeutralAgreeStrongly agree IntegrationI have integrated the love of my late partner with my current life and relationships*Strongly disagreeDisagreeNeutralAgreeStrongly agreeI have found ways to honor my deceased partner or spouse*Strongly disagreeDisagreeNeutralAgreeStrongly agreeI have blended my past life with my present life*Strongly disagreeDisagreeNeutralAgreeStrongly agreeI have created a new life that honors the past*Strongly disagreeDisagreeNeutralAgreeStrongly agree Goals & GrowthI can picture a positive and happy future*Strongly disagreeDisagreeNeutralAgreeStrongly agreeI have goals I am working toward*Strongly disagreeDisagreeNeutralAgreeStrongly agreeI like the person I am now*Strongly disagreeDisagreeNeutralAgreeStrongly agreeI feel stronger because of what I've overcome*Strongly disagreeDisagreeNeutralAgreeStrongly agree You are one step away from completing the assessment. Please enter your email and click on the submit button below to receive your personalized score.Email* What, if any, resources of Soaring Sprits have you accessed? Camp Widow Newly Widowed Virtual Call Regional Social Group (in-person) Regional Social Group (virtual) Community Specific Virtual Group (Men’s, LBGTQ+, Black and Widowed) Widowed Village Pen Pal Program Widow’s Voice Blog Other OtherHave you taken the Resilience Scale before? Yes No CAPTCHAEnter this code into the field below.EmailThis field is for validation purposes and should be left unchanged. Δ
