Take 3 minutes to let us know more about you...
Information is completely confidential and will not be shared with anyone outside of the research team.
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Are you currently married to an active duty military person? *

     
 
Is your spouse currently deployed or on an extended separation? *

     
 
Do you have regular access to the internet via a computer, tablet, or mobile phone? *

     
 
Are you willing to commit to a program for this 10-week period? *

The program will start Saturday, April 8, 2017 and run for 10 weeks
     
 
How did you hear about this study? *

 
How many people, including you and your spouse, live in your household? *










 
What is the highest level of education you have completed? *


 
Tell us why you would like to participate in this program *

 
What is your gender? *



 
What is your age? *


 
Please provide us your contact info below

This information is in order for us to send you an informed consent form. We do not sell or provide your information to any external party, nor will you be contacted in regards to anything unrelated to this program.
 
First Name *

 
Last Name *

 
A good contact phone number *

 
Your mailing address *

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