Under repair
<p><b>It is very important for the study that your responses accurately reflect your true opinion/feeling.
Therefore, please consider each item carefully.</b> </p>
<p>If you were developing a relationship with a friend or a romantic partner, you would probably ask yourself: <br />
<em>Can I count on this person to be there for me emotionally at difficult times when “the chips are down?”</em> </p>
<p>People sometimes use indicators or signs to help them answer questions like these about potential or current friends or romantic partners. Below you will find examples of some indicators. Imagine yourself developing a relationship with someone new. Please rate each indicator to tell how useful an indicator you think it would be. </p>
<form name="countForm" method="post" action="<?=$_SERVER['PHP_SELF']?>" onsubmit="return _submitIt( this )">
<table cellspacing="0" cellpadding="0" border="0" style="border: 1px solid black; padding: 5px; margin-top: 10px;">
<tr>
<td align="left"><table border="0" cellpadding="3" cellspacing="0">
<tr>
<td width="100%" align="left"><h2>Background Information </h2>
<table width="100%" border="0" cellspacing="3" cellpadding="0">
<tr>
<td valign="top"><strong>Age: </strong></td>
<td valign="top"><input type="text" name="age" size="3" maxlength="3" /></td>
<td align="left" valign="top"> </td>
<td align="left" valign="top"><strong>Currently in a <br />
romantic relationship:</strong></td>
<td valign="top"><input type="radio" name="current" value="Y" />
yes </td>
<td valign="top"><input type="radio" name="current" value="N" />
no</td>
</tr>
<tr>
<td valign="top"> </td>
<td valign="top"> </td>
<td align="left" valign="top"> </td>
<td align="left" valign="top"> </td>
<td valign="top"> </td>
<td valign="top"> </td>
</tr>
<tr>
<td valign="top"><strong>Ethnicity: </strong></td>
<td valign="top"><select name="ethnicity">
<option value="" selected="selected">Please select...</option>
<?php
for ( $i = 0; $i < $ethnicityCount; $i++ )
{
?>
<option value="<?=$ethnicity[$i] ?>"><?=$ethnicity[$i]?></option>
<?php
}
?>
</select></td>
<td align="left" valign="top"> </td>
<td align="left" valign="top"><strong>Gender:</strong></td>
<td valign="top"><input type="radio" name="gender" value="M" />
male </td>
<td valign="top"><input type="radio" name="gender" value="F" />
female</td>
</tr>
<tr>
<td valign="top"> </td>
<td valign="top"> </td>
<td align="left" valign="top"> </td>
<td align="left" valign="top"> </td>
<td valign="top"> </td>
<td valign="top"> </td>
</tr>
<tr>
<td valign="top"><strong>Religion: </strong></td>
<td valign="top"><select name="religion">
<option value="" selected="selected">Please select...</option>
<?php for ( $i = 0; $i < $religionCount; $i++ ) { ?>
<option value="<?=$religion[$i] ?>"><?=$religion[$i] ?></option>
<?php } ?>
</select></td>
<td align="left" valign="top"> </td>
<td align="left" valign="top"><strong>Native English speaker:</strong></td>
<td valign="top"><input type="radio" name="speaker" value="Y" />
yes</td>
<td valign="top"><input type="radio" name="speaker" value="N" />
no</td>
</tr>
</table>
<br /></td>
</tr>
</table></td>
</tr>
<tr>
<td><h2>Questions</h2>
<em>On a scale from 1 to 8, in determining how much you can count on this person to "be there" <br />
for you, rate how informative/important the following items are:</em></td>
</tr>
<tr>
<td align="left"><table width="100%" border="0" cellpadding="0" cellspacing="0">
<?php
for ( $x = 0; $x < $questionCount; $x++ ) {
?>
<tr>
<td colspan="3"><hr noshade="noshade" size="1" /></td>
</tr>
<tr>
<td align="left" valign="bottom" nowrap="nowrap"><?=( $x + 1 ) ?>
: </td>
<td align="left" valign="bottom" nowrap="nowrap"><?=$questions[$x] ?>
</td>
<td align="left" valign="bottom" nowrap="nowrap"><table border="0" cellspacing="0" cellpadding="0">
<tr>
<?php for ( $i = 1; $i <= 8; $i++ ) { ?>
<td width="12%" class="number" align="center"><?=$i ?></td>
<?php } ?>
</tr>
<tr>
<?php
for ( $i = 1; $i <= 8; $i++ ) {
$qNumber = sprintf ( "%02d", ( $x + 1 ));
?>
<td width="12%" align="center"><input type="radio" name="q<?=$qNumber ?>" value="<?=$i ?>" /></td>
<?php } ?>
</tr>
</table></td>
</tr>
<?php } ?>
<tr>
<td colspan="3"><hr noshade="noshade" size="1" /></td>
</tr>
</table></td>
</tr>
<tr>
<td align="left"><br />
I understand that no identifying information is included in this data.<br />
In submitting this data, I give permission for its unlimited use in research.<br /></td>
</tr>
<tr>
<td align="left"><input name="submit" type="submit" value="Submit the questionaire." />
<input name="reset" type="reset" value="Erase all answers from the questionaire" /></td>
</tr>
<tr>
<td> </td>
</tr>
</table>
</form>
<?php
} else { // $submitted
if ($returnValue == "")
{
?>
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<br>
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