Family Orientation Questionnaire You can fill out our questionnaire below or if you prefer… Download the Solace Tree Family Orientation Questionnaire (PDF) If you are a human and are seeing this field, please leave it blank. Fields marked with an * are required Preference of Group Night: * MondayWednesday State * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Please list all participating family members, including you self, other adults, teens, and children Age Age Age Age Age Age Questions about the person who died: How was the deceased related to the child/teen? FatherMother Step-Father Step-Mother Brother Step-BrotherSisterStep-SisterGrandparent Teen FriendOther (Please Specity) If other, please specify How was the deceased related to you? WifeHusbandEx-WifeEx-Husband DaughterSonMotherFatherSisterBrotherOther (Please Specity) If other, please specify Age The Person Died at: HomeHospitalHospiceWorkOther If other, please specify Causes, Circumstances and Location of Death: Questions about your family: What other deaths have your child/teen experienced and approximate dates? (friends, relatives, pets, ect.} What other Changes have your child/teen experienced (moved, changed schools, jobs, etc} since the death OPTIONAL Family's Nationality(ies) African AmericanCaucasian/European AmericanNative American lndianAsian AmericanLatin American/HispanicMiddle Eastern AmericanOther If other, please specify If you are a human and are seeing this field, please leave it blank.