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1.

* Your gender

Male

Female

* How old are you?

* How many children do you have and what is their age?

4.

* Who lives together with you in your household?

5.

* Does your family attend church regularly?

yes

no

yes, but not all the members of the family

no, but wish we were

6.

* On average how many hours a day does your family watch television (DVDs and videos included)?

About 5-8 hours

2-5 hours

Up to two hours a day

We don't watch TV

* What are the programs watched the most?

8.

* Does television affect your family in a _____________ way?

positive

negative

neutral (doesn't affect)

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