From: "Surveys" survey@lists.scientology.net
Date: May 25, 2005
Subject: Scientology Parents Survey

Dear xxxxx,

If you are the parent of a child/children between the ages of 5 and 19, please answer the below survey.

Data is being gathered regarding possible Scientology courses you would like to have available for your children to take. These would be courses specifically designed for children and/or teenagers.

Sincerely, Rick Siegel Survey Network Chief Church [sic] Of Scientology International

(Important: Hit reply to fill in your answers. Type your answer between the brackets, using as much space as necessary. Don't worry about extra spaces at the end of your response. On answers that are multiple choice such as yes/no please place your X between the square brackets and select only one choice unless directed to choose more than one or as many as necessary.)

Q. Qualifier
Are you the parent of a child/children between the ages of 5 and 19?

[ ] Yes
 [ ] No

If yes, please do the rest of the survey.

Q. 1
Is there a matter of concern in your child's life which you would like to see addressed by a Scientology course?

[ ] Yes
 [ ] No

Q. 2
If yes, please describe the situation or condition that you would like to see handled for your child or children, through a Scientology course.

[ ]

Q. 3
What sort of data would you like to see on such a course, to address this concern?

[ ]

Q. 4
Is there an existing Scientology course which you would like to see available in a format applicable for young people?

[ ] Yes
 [ ] No

Q. 4a
If you answered yes to question 4, please state what the course is...

[ ]

Q. 5
Is there anything else you'd like to say regarding Scientology courses for young people?

[ ] Yes
 [ ] No

Q. 5a
If so, please state what...

[ ]

Q. Children
How many children do you have between the ages of 5 and 19

[ ] One
 [ ] Two
 [ ] Three
 [ ] Four
 [ ] More than four

Q. Country
What country/area do you live in...

[ ] Australia/New Zealand/ Oceania
 [ ] Canada
 [ ] Europe (not including Great Britain or CIS)
 [ ] Latin America/South America
 [ ] Russia/CIS
 [ ] South Africa/Zimbabwe
 [ ] United Kingdom and Ireland
 [ ] United States East of the Mississippi
 [ ] United States West of the Mississippi
 [ ] Middle East
 [ ] Africa (not including South Africa/Zimbabwe)
 [ ] Japan/Taiwan/Indochina/China
 [ ] Asia/South Asia (India, Pakistan, Afghanistan)

Q. Training
What is the highest auditor training level you have achieved?

[ ] Division 6 Courses
 [ ] Book Auditor (HDS, HDA etc.)
 [ ] Student Hat/Study Certainty
 [ ] M1/Trs & Objs
 [ ] Pro Trs/Upper Indoc Trs
 [ ] Pro Metering
 [ ] Academy Levels
 [ ] NED
 [ ] Class V Grad
 [ ] On Or Completed SHSBC
 [ ] Class VIII
 [ ] SOLO Part I Course

Q. Processing
What is the highest processing level you have achieved?

[ ] None
 [ ] Pre-Clear
 [ ] Clear
 [ ] Pre-OT (OT I-OT VII)
 [ ] New OT VIII

Q. RecID
Your Record ID is (note this is for our internal use only): [xxxxx]

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