What post-high school education do you have? _______________________________________

What jobs did you hold before this marriage?

Were you employed when you got married? Yes _____ No _____

If yes, what was your position? ________________________ Salary $_____ per _____

If no, explain.

Have you obtained additional education or developed new skills during your marriage?

Yes _____ No _____

If yes, explain.

Are you in good health? Yes _____ No _____

Explain any health-related limitations on your being self-supporting.

Explain any non-health related limitations on your being self-supporting (e.g., child care responsibilities, currently in school, extended absence from job market, lack of marketable skills, transportation concerns, etc.)