How old were you when your parent(s) died?
Mother:   Father:

(eg. I was 15 when my mother died and 4 when my father died)

How did they die?

Do you have siblings?      Yes   No

How did your world change?

After your parent(s) died, did anyone say anything that hurt your feelings or you wish they did not say? If yes, what did they say and why did you not like it?

What could they have said instead, and why?

Did you feel that others were uncomfortable around you?
If so, what did they do to make you feel that way?

Did anyone say something that was hurtful and you wish they knew better?

If you could give a tip to a child whose mother or father died, what would it be?

If you could share words of wisdom with an adult who takes care of a child whose parent(s) died, what would you say?

Is there anything else you would like to share with us?

Tell us about yourself, what is your occupation?
Did the death of your parent(s) impact your choice of occupation in any way?

Did you attend college? If no, please enter "no" and skip to next question.
If yes, where? What degree(s) did you earn? How did you pay for college?

Is there anything else you would like to say?

Optional, but desired, information:

First Name:
Last Name:
Address:
City, State Zip:	ALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY
Age:
Email:
Phone:
Mother's Name:
Father's Name:
Try a different image.

Thank you for your time and insight. Once this information is compiled it will be available on this website.