Sorry, there was a problem connecting to the Ci2i Survey database Ci2i Survey Registration Form

 

All of your input, anywhere within Ci2i, is extremely safe and totally confidential. We do not retain email addresses. names, Survey IDs, or passwords, and we certainly cannot share something we don't have with anyone else. For your protection, we have taken several extra precautions to make sure everything you do with Ci2i is secure, anonymous, and confidential.

If you are willing to give us your opinions, please use the FEEDBACK link on the right side of the page inside the actual survey. Demographic information is also optional. If you will take a moment to provide it for us, it will be used in aggregate with all other survey data for research purposes only.

Thank you very much,

The Ci2i Research Team

I have read and understood what Ci2i is and is not. I know it is not a therapy instrument or counseling tool. I realize there are no right or wrong answers. I also understand that the demographic information I supply cannot and will not be linked to me personally in any way, and all information from any part of this survey will only be used by Ci2i for summary research purposes.

Items marked in red are required.

  Partner One   Partner Two
First Name:  
City:  
State:  
Zip Code:  
Province (international only):  
Postal Code (international only):  
Country:  
Email:  
  Email addresses are required to send you your passwords. We highly recommend using two separate email addresses, however checking this box confirms that you want to use the same email address for each partner:
  Demographic information...
Gender:  
Age:  
Primary Ethnic Connection:  
Religion:  
Nbr. of Children:  
Nbr. of Children (shared with partner):    
Nbr. of Pets (shared with partner):    
  How do you spend your time in a typical week?
I work primarily: Inside the home
Outside the home
  Inside the home
Outside the home
Hours worked:  
Hours watching TV:  
Hours spent on leisure reading:  
Hours spent on hobbies:  
Hours of physical activity:  
Quality hours with partner:  
Quality hours with children:  
Leisure time spent on email:  
Leisure time spent on the web:  
Leisure time spent with friends:  
Leisure time spent with relatives:  
  In what way are you committed to each other?
Relationship Type:
Nbr. of Years in this relationship:    
Nbr. Past Commited Relationships:  
  Other...
Education Level:  
Profession:  
Living Area: Rural
Suburban
City
Other:
  Rural
Suburban
City
Other:
Place of residence: I live with my partner
I sometimes live with my partner
Own my home
Rent my home
Live with friends
Live with relatives
Other:
  I live with my partner
I sometimes live with my partner
Own my home
Rent my home
Live with friends
Live with relatives
Other:
Income Level:  
How satisfied are you with life right now:  
       
 
       
Again, thank you, we are very grateful to you for taking a few moments to answer these questions.