8. Your history. Which of the following have ever occurred?

  Before attending ABLE program While attending ABLE program After leaving ABLE program
Arrested      
Jail time      
On Probation      
Filed for Bankruptcy      
Been Sued      

Have had Medical problems      
Had Alcohol Treatment      
Had Drug Treatment      
Had Counseling      
Had Mental Health Treatment      
Been in a serious accident      

Obtained US citizenship      
Obtained a driver's license      
Completed reading a book      
Voted in a state or national election      
Had an article published      
Addressed a state or national audience      

9.

On a scale of 1 to 5 with 1 being ''there are major problems,'' 5 being ''things are excellent'' and 3 being ''average'' give a numerical rating to each of the following.
(leave blank if item does not apply)

Your job
1 2 3 4 5
Your marriage
1 2 3 4 5
Your children
1 2 3 4 5
Your home
1 2 3 4 5
Your education
1 2 3 4 5
Your parenting skills
1 2 3 4 5
Your job skills
1 2 3 4 5
Your physical health
1 2 3 4 5
Your financial status
1 2 3 4 5
Your self confidence
1 2 3 4 5
Your overall happiness
1 2 3 4 5
Your expectations for the future
1 2 3 4 5

Adult Learner Code:_________ Interviewer’s Initials: ______ Interview Date______

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