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UCLA Stress Study - Screening Question

1. In the last month, have you felt... *This question is required.

Space Cell	Yes	No
You were unable to control the important things in your life	You were unable to control the important things in your life: Yes	You were unable to control the important things in your life: No
Confident about your ability to handle your personal problems	Confident about your ability to handle your personal problems: Yes	Confident about your ability to handle your personal problems: No
That things were going your way	That things were going your way: Yes	That things were going your way: No
Your troubles or problems were piling up so high that you could not overcome them.	Your troubles or problems were piling up so high that you could not overcome them.: Yes	Your troubles or problems were piling up so high that you could not overcome them.: No

2. Participant Name and Contact Info

First Name *This question is required.

Last Name *This question is required.

City

Email Address

Phone Number

Mobile Phone