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QUESTIONNAIRE

This document contains a survey asking for general information about the respondent such as family size and parental presence at home. It then contains several statements to gauge the respondent's motivation, ability to handle adversity, and self-reliance. The respondent is asked to rate how strongly they agree or disagree with statements related to their self-worth, qualities, satisfaction, usefulness, attitude, and feelings of failure. It also contains statements to understand how they learn from mistakes, are affected by criticism, can change behavior, avoid trouble, and handle tough situations. Finally, it has statements regarding independence, leadership, seeking approval or help from others, and reliance on a significant other. The respondent is asked to rate their level of

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Kerby
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2K views2 pages

QUESTIONNAIRE

This document contains a survey asking for general information about the respondent such as family size and parental presence at home. It then contains several statements to gauge the respondent's motivation, ability to handle adversity, and self-reliance. The respondent is asked to rate how strongly they agree or disagree with statements related to their self-worth, qualities, satisfaction, usefulness, attitude, and feelings of failure. It also contains statements to understand how they learn from mistakes, are affected by criticism, can change behavior, avoid trouble, and handle tough situations. Finally, it has statements regarding independence, leadership, seeking approval or help from others, and reliance on a significant other. The respondent is asked to rate their level of

Uploaded by

Kerby
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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GENERAL INFORMATION

Name (Optional): Type of Community Living (Rural or Urban):

Family Size: Birth Order (First, Middle, Last, or Only Child):

Parental Presence at Home (Not at all, Sometimes, Always):

MOTIVATION
Statement Strongly Agree Disagree Strongly
Agree disagree
1. I feel that I am a person of worth, at least an equal
with others.
2. I feel that I have a number of good qualities.

3. I feel I do not have much to be proud of.

4. I am able to do things as well as most other people.

5. I take a positive attitude toward myself.

6. On the whole, I am satisfied with myself.

7. I certainly feel useless at times.

8. At times, I think I am no good at all.

9. I know when I am good with something.

10. All in all, I am inclined to feel that I am a failure.

Quotient Adversity
Statement Strongly Agree Disagree Strongly
Agree disagree
1. I learn from my mistakes.

2. I feel down if others belittle me.

3. I can’t focus on anything else while worrying.


4. It is easy for me to be submissive towards others.

5. Im prepared to deal with the consequences of my


actions.
6. I can change my behavior to match the situation.

7. I avoid situation where I could get trouble.

8. I avoid people who could get me into trouble.

9. When my work is criticized, I try harder next time.

10. When im faced with tough situation, I can come up


with new ways to handle it.

Self Reliance
Statement Strongly Agree Disagree Strongly
Agree disagree
1. I know when I am good with something.

2. I can usually achieve what I want if I work hard for it.

3. Im not a big fan of asking others for help.

4. I always form my own opinions with no outside


influence.
5. I always seek out the advice of others, especially
when I have to make a big decision.
6. In my view, I lack strong leadership skills.

7. To boost my self-esteem, I have always sought


approval of my parents or teachers.
8. When I feel ill or tired, I prefer to be left alone rather
than fawned over.
9. If I know ahead of time that I will be highly praised
for doing a good job on a task that makes me work
even harder than I normally would.
10. If I didn’t have my significant other in my life, I would
feel utterly adrift.

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