ASPIRE Registration Form

Over the last 2 weeks, how often have you been bothered by any of the following problems?

Instructions: Listed below are a number of difficult or stressful things that sometimes happen to people. For each event check one or more of the boxes to the right to indicate that: (a) it happened to you personally; (b) you witnessed it happen to someone else; (c) you learned about it happening to a close family member or close friend; (d) you were exposed to it as part of your job (for example, paramedic, police, military, or other first responder); (e) you’re not sure if it fits; or (f) it doesn’t apply to you. Be sure to consider your entire life (growing up as well as adulthood) as you go through the list of events.

Over the last two weeks, how often have you been bothered by the following problems?