Helen | QuestionPro

BELOW IS A LIST OF STATEMENTS DEALING WITH YOUR GENERAL FEELINGS ABOUT YOURSELF. IF YOU STRONGLY AGREE, CHOOSE SA. IF YOU AGREE WITH THE STATEMENT, CHOOSE A. IF YOU DISAGREE, CHOOSE D. IF YOU STRONGLY DISAGREE, CHOOSE SD.

* I feel that I'm a person of worth, at least on an equal plane with others.

SA

A

D

SD

* I feel that I have a number of good qualities.

SA

A

D

SD

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

SA

A

D

SD

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

SA

A

D

SD

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

SA

A

D

SD

* I take a positive attitude toward myself.

SA

A

D

SD

* On the whole, I am satisfied with myself.

SA

A

D

SD

* I wish I could have more respect for myself.

SA

A

D

SD

* I certainly feel useless at times.

SA

A

D

SD

* At times I think I am no good at all.

SA

A

D

SD

The following questions will help categorize your answers. They will not be used in any way to identify individuals.
PLEASE CIRCLE THE RESPONSE THAT BEST IDENTIFIES YOU.

* I attended church regularly as a child.

YES

NO

* I attend church regularly today.

YES

NO

* What gender are you?

MALE

FEMALE

* How old are you?