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Life Insights - Adult Self-Evaluation

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1. Hello Valued Life Insights' Client:

ACCEPTANCE OF THE FOLLOWING STATEMENTS REPRESENT A LEGAL COMMITMENT BY YOU SO PLEASE READ THE FOLLOWING VERY CAREFULLY!

Welcome to the Life Insights Adult Self Evaluation Questionnaire that is designed for adults 21 and older. The purpose of this questionnaire is to create a baseline of your self perceptions as a basis for identifying self-imposed limitations and opportunities for optimizing your future. A Life Insights mentor will review your data and schedule a time to discuss the results with you to clarify a mutual understanding and chart a path forward.

This data will be a reference point in Phase 3 of the Life Insights process where you will review the Life Insights summary of axioms and insights. Phase 3 is designed to introduce you to a higher awareness that will hopefully advance your life progression to achieve your goals and ambitions by providing you with a competitive advantage versus your peers.

The survey is somewhat lengthy in an an effort to create a comprehensive evaluation, but please take your time and carefully consider the answers to each question before answering. The end results of the Life Insights process are directly correlated to the accuracy and complete candor of your responses to this questionnaire. The answers are completely confidential so this is an opportunity to take a serious look at yourself in a systematic way.

This questionnaire is not a test, and your participation in this process is completely voluntary and for your personal benefit. There are no foreseeable risks associated with this process. However, if you feel uncomfortable answering any questions, you may ignore individual questions or you can withdraw from the questionnaire at any point.

Your questionnaire responses will be strictly confidential and data from this process will be reported only to you or those authorized by you in writing. However, if you anticipate releasing this data to others, you should carefully consider the consequences. You can complete a separate questionnaire that you want to release to others. Your information will be coded and will remain confidential. If you have questions at any time about the questionnaire or the procedures, you may contact [email protected]

By checking the box below you certify that you are an adult over the age of 18 of sound mind and have never been diagnosed with any psychiatric disorder. You acknowledge that you are not under the care of a psychological or psychiatric care professional. You accept that Life Insights, LLC or its owners or employees incur no liability to you of any kind by allowing you to complete this questionnaire. You understand that Life Insights mentors are not licensed counselors or psychiatric professionals. You acknowledge that you and you alone are responsible for your actions or the consequences that might result from this process. If you choose to release data from this questionnaire to others, you accept full responsibility for the consequences and will hold Life Insights harmless.

DO NOT PROCEED WITH THIS QUESTIONNAIRE IF YOU ARE NOT IN COMPLETE AGREEMENT WITH THE STATEMENTS ABOVE OR ARE NOT EMOTIONALLY CAPABLE OF DEALING WITH ANY REACTIONS OR RESPONSES THAT MAY ARISE FROM OTHERS YOU DESIGNATE TO SEE YOUR RESPONSES !! THEIR REACTIONS ARE YOUR RESPONSIBILITY ONLY!!

Important Notice: The questionnaire format and its content are copyrighted, highly confidential and the proprietary property of Life Insights, LLC. They are not to be copied by anyone for any purpose.

Thank you very much for your time and interest. Please start by selecting the "I Agree" button below and then clicking on the Continue button below.

 
 
 
2. Your Contact Information
* First Name : 
* Last Name : 
* Address 1 : 
   Address 2 : 
* City : 
* State : 
* Zip : 
* Phone : 
* Email Address : 
 
 
 
3. Please confirm your relationship to the person you are evaluating in this questionnaire?
 
Myself
 
 
 
4. Please enter your name
   
Your birthplace
   
Your birth nationality
   
Your current nationality
   
 
 
 
5. Where were you in the birth order of your original family?
 
Only Child
 
1.
 
2.
 
3.
 
4.
 
5.
 
6.
 
7.
 
8.
 
9.
 
10.
 
How many total siblings including you?
 
 
 
 
6. How would your rate your birth family/socioeconomic circumstances versus other people in your society?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
7. How would you rate your childhood? Please comment briefly
 
1. Terrible
 
2.
 
3. Not good
 
4.
 
5. Average
 
6.
 
7. Good
 
8.
 
9. Very good
 
10. Excellent
 
Briefly comment

 
 
 
8. How would you rate your childhood upbringing versus other people in your society?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
9. Please rate the quality of the educational opportunities you had as a child.
 
1. Very poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
10. Overall, rate your father as a parent.
 
0. Not applicable
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
How many times was he married? Which marriage were you born in? How many half siblings do you have through him? How many current step-siblings through him?

 
 
 
11. Please describe your current relationship with your father.
 
0. Deceased
 
1. We have no relationship
 
2. We do not get along well
 
3. He does not care about me & we seldom communicate
 
4. He ignores me most of the time
 
5. He cares about me but we seldom communicate
 
6.
 
7.
 
8. He loves me. We are close and communicate often
 
9.
 
10. He loves me very much. We are very close and communicate very frequently
 
Please comment

 
 
 
12. Overall, rate your mother as a parent.
 
0. Not applicable
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
How many times was she married? Which marriage were you born in? How many half siblings do you have through her? How many current step-siblings through her?

 
 
 
13. Please describe your current relationship with your mother.
 
0. Deceased
 
1. We have no relationship
 
2. We do not get along well
 
3. She does not care about me & we seldom communicate
 
4. She ignores me most of the time
 
5. She cares about me but we seldom communicate
 
6.
 
7.
 
8. She loves me. We are close and communicate often
 
9.
 
10. She loves me very much. We are very close and communicate very frequently
 
Please comment briefly
 
 
 
14. How would you rate the affection you received from your parents as a child?
 
0. Not applicable
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
15. Were you physically abused a child?
 
1. Often
 
2.
 
3.
 
4.
 
5. Infrequently
 
6.
 
7.
 
8.
 
9.
 
10. Never
 
Describe Briefly if you want to comment

 
 
 
16. Were you verbally or emotionally abused or neglected as a child?
 
1. Often
 
2.
 
3.
 
4.
 
5. Infrequently
 
6.
 
7.
 
8.
 
9.
 
10. Never
 
Describe briefly if you want to comment

 
 
 
17. How would you rate your intellect versus people in general in your society?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
18. How would you rate your overall personal appearance versus others in your age group?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
19. Overall and historically, how would you rate yourself as an athlete?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
20. From an overall behavioral perspective, rate yourself as a child versus your peer group.
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
21. How would you rate yourself as a student? (past or present tense)
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
22. Please confirm your education level
 
0. Currently in high school
 
1. Did not complete high school
 
2.
 
3. GED
 
4.
 
5. High school diploma
 
6. Some college
 
7. Associate degree or Technical certification
 
8. Bachelors degree
 
9. Masters Degree
 
10. Doctorate or more
 
 
 
23. Please rate your career achievement versus your age peers.
 
0. Not applicable - Still a full time student
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
24. Please rate your overall career job income performance versus your age peers.
 
0. Not applicable - Still a full time student
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
25. Please rate your current income performance versus your age peers.
 
0. Not applicable - Still a full time student
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
26. How would you rate your current family/socio-economic circumstances versus other people in your society?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
27. How would you rate your boss?
 
0. Not applicable - Not employed or Self-Employed
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
28. How would you rate your career versus your aspirations at this point?
 
0. Not Applicable - Young Adult
 
1. Much worse than I had hoped
 
2.
 
3.
 
4.
 
5. About what I expected
 
6.
 
7.
 
8.
 
9.
 
10. Much better than I ever expected
 
 
 
29. How would you rate yourself as a financial provider now?
 
0. Not applicable - Young adult only
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
30. How would you rate your future career prospects?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Okay
 
6.
 
7.
 
8. Good
 
9.
 
10. Great
 
 
 
31. How would you rate your current lifestyle versus your aspirations for your current age?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
32. How do you rate yourself as an achiever versus your age peer group and your potential?
 
1. Extreme underachiever
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Extreme overachiever
 
 
 
33. How would you rate yourself as a boss?
 
0. Not Applicable - I have never been a boss
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
34. How would you rate yourself as an employee?
 
0. Not applicable - Never had a job
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
35. Is the future more of a problem or an opportunity for you?
 
1. A big problem
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. A big opportunity
 
 
 
36. Generally, how would you rate your happiness?
 
1. Very unhappy
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Very happy
 
 
 
37. Overall, how would you rate your feelings about your future?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
38. How much of your life potential have you achieved given your current age?
 
1. Very little
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. All of it so far
 
 
 
39. Overall, how would you rate your life experience to date?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
40. How would you rate your general outlook?
 
1. Negative
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Very Positive
 
 
 
41. How do you feel about America's future?
 
1. Things are bad now and are likely to get worse in the future
 
2. Things are bad now and are likely to stay bad in the future
 
3. Things are bad now but are likely to get better in the future
 
4. Things are okay now but are likely to get worse in the future
 
5. Things are okay now and likely to stay okay in the future
 
6. Things are okay now but are likely to get better in the future
 
7. Things are good now but likely to get worse in the future
 
8. Things are good now and likely to remain good in the future
 
9. Things are good now and likely to get better in the future
 
 
 
42. How would you rate yourself as a competitor?
 
1. I prefer not to compete
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Very competitive
 
 
 
43. How would you rate your breadth of knowledge versus your age group?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
44. How would you rate your sense of style versus other people in your peer group?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
45. Generally, how would you rate your tactfulness?
 
1. Not al all
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Very tactful
 
 
 
46. How persuasive are you?
 
1. Not at all
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Very persuasive
 
 
 
47. How would you rate your charisma?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Very
 
 
 
48. How reliable is your intuition?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
49. How would you rate your sense of humor versus other people in general?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
50. How would you rate yourself as a conversationalist?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
51. How would you rate your overall social skills versus other people?
 
1. Poor (Very shy)
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent (Very Gregarious)
 
 
 
52. How well are you generally liked by other people?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
53. How would you rate your self confidence versus your age peer group?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
54. How would you rate yourself as a hard worker?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
55. How would you rate yourself as a learner?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
56. How would you rate your imagination?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
57. How would you rate yourself as a listener?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
58. How would you rate yourself as a writer?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
59. How would you rate yourself as a reader?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
60. How would you rate your overall personality versus other people?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
61. How would you rate yourself as a leader?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
62. How would you rate your level of curiosity/inquisitiveness?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
63. How do you rate yourself as a follower versus a leader?
 
1. Follower
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Leader
 
 
 
64. Are you generally reactive or proactive?
 
1. Reactive
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Very Proactive
 
 
 
65. Overall, how do you rate your analytical/reasoning ability?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
66. How do you rate your artistic ability?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
67. How do you rate your musical abilities?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
68. How do you rate your mathematics ability?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
69. How do you rate your mechanical/engineering/scientific understanding ability?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
70. How would you rate your business analytical abilities?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
71. How would you rate your ability to change, adapt and grow?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
72. How would you rate your ability to effectively prioritize things?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
73. How would you rate your ability to focus on tasks assigned?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
74. How would you rate your ability to innovate?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
75. How would you rate your public speaking ability?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
76. How would you rate your ability to intuitively sense other people's perspectives?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
77. How would you rate your ability to express your thoughts and feeling verbally?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
78. How would you rate your ability to productively multi-task?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
79. Overall, how would you rate your ability to communicate?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
80. How would you rate your ability to express your thoughts and feelings in writing?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
81. How would you rate your ability to maintain your composure in stressful situations?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
82. How would you rate your ability to make difficult decisions?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
83. How would you rate your ability to overcome adversity?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
84. How would you rate your ability to get things done in a timely fashion?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
85. How would you rate your internet and computer literacy versus your age group?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
86. How much international travel have you experienced versus your age group?
 
1. None
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. A lot of international travel
 
 
 
87. How would you rate your knowledge of history versus other people?
 
1. Very little knowledge
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Very knowledgable
 
 
 
88. How do you rate your knowledge of politics and government versus other people?
 
1. Very little knowledge
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Very knowledgeable
 
 
 
89. How much do you follow global events?
 
1. Not at all
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. A lot
 
 
 
90. How would you rate your "Common Sense"?
 
1. Very poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
91. How would you rate your ability to see "The Big Picture" of situations?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
92. How well would you rate your ability to see "The Big Picture" of life?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
93. How easy is it for you to admit when you have been wrong about something & apologize if appropriate?
 
1. Very difficult
 
2.
 
3.
 
4.
 
5. Not easy
 
6.
 
7.
 
8.
 
9.
 
10. Very easy
 
 
 
94. How would you rate your emotional health and stability versus other people in general?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
95. How do you react to constructive criticism?
 
1. With hostility
 
2.
 
3. Very defensively
 
4.
 
5. Defensively
 
6.
 
7. I ignore it
 
8.
 
9. With gratitude even if I disagree
 
10. With gratitude and careful consideration
 
 
 
96. How would you rate your ability to control your temper?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
97. How do you act when you are very angry with someone?
 
1. I am physically hostile
 
2.
 
3. I am verbally hostile
 
4.
 
5. I internalize it and build resentments
 
6.
 
7. I vigorously try to convince them that I am right
 
8. I walk away to cool off
 
9.
 
10. I maintain composure and offer solutions to resolve the conflict
 
Other: Please Describe Briefly
 
 
 
 
98. How often do you get very angry or hostile toward someone?
 
1. Almost every day
 
2.
 
3.
 
4.
 
5. Often
 
6.
 
7.
 
8.
 
9. Almost never
 
10. Never
 
 
 
99. How motivated and goal oriented are you versus your peer group?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
100. Overall, how open minded are you?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
101. Given a choice, would you rather be right or happy and successful?
 
1. Right
 
2. Happy and successful
 
 
 
102. How would you rate your self-esteem?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
103. How would your rate your decisiveness?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
104. How well do you take responsibility for your own happiness?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
105. How well do you take responsibility for your own life?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
106. Are you generally on time?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
107. Overall, how would you rate your reliability?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
108. How well do you function when you are alone in your life?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
109. How would you rate your housekeeping habits?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
110. How would you rate your emotional maturity level versus your age peer group?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
111. How would you rate your patience overall?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
112. How do you rate yourself on stubborn versus flexible?
 
1. Very stubborn
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Very flexible
 
 
 
113. How well do you manage stress?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
114. How would you rate your level of self-discipline?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
115. How do you rate your ability to make and keep quality friendships.
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
116. How do you think and make decisions?
 
1. Very emotional
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Very rational
 
 
 
117. How would you rate your level of self-motivation?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
118. Overall, are you more dependent or independent?
 
1. Dependent
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Independent
 
 
 
119. Overall, how organized are you?
 
1. Very disorganized
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Very organized
 
 
 
120. How set in your ways are you?
 
1. Very set in my ways
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Changing all the time
 
 
 
121. Overall, are you more lazy or energetic?
 
1. Very lazy
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Very energetic
 
 
 
122. How motivated are you to excel and achieve versus your peer age group?
 
1. Not motivated
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Very motivated
 
 
 
123. Generally, are you more inclined to make excuses or get results?
 
1. Make excuses
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Get Results
 
 
 
124. How important is your ability to make good choices to your success in life?
 
1. Not important
 
2.
 
3.
 
4.
 
5. Important
 
6.
 
7.
 
8.
 
9.
 
10. Very important
 
 
 
125. How important is your ability to compete to success in your life?
 
1. Not important
 
2.
 
3.
 
4.
 
5. Important
 
6.
 
7.
 
8.
 
9.
 
10. Very important
 
 
 
126. How would you rate your personal life judgment overall?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
127. How would you rate your professional judgment versus your age peer group?
 
0. Not applicable - Still a full time student
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
128. Overall, how would you rate your ability to judge people accurately?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
129. How would you rate your financial judgment overall?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
130. How would you rate your overall personal judgment with friends in your life?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
131. How would you rate your overall personal judgment with significant others in your life to date?
 
0. Not applicable - No significant others yet
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
132. How would you rate your physical health versus your age group peers?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
If you have health issues, rate them from 1 to 10 with "All My Fault" being 1 and "All Genetic" being 10. Comment if you want to.

 
 
 
133. How would you rate your current weight for your age group?
 
1. Obese
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Ideal
 
 
 
134. What is your current status and marital history?
 
Single - never married
 
Separated
 
Separated but previously divorced
 
Divorced
 
Married
 
Married but previously divorced
 
If married, what year & spouses full name? If separated, what was separation date? If divorced or previously divorced, how many times and what year(s) divorced with length of each previous marriage

 
 
 
135. How many adopted or step-children do you have?
 
None
 
1
 
More than 1
 
Please list each child's full name and age & whether adopted or step-child or both. Please rate your relationship with each child from (1) Poor to (10) Excellent

 
 
 
136. How many biological children do you have?
 
None
 
1
 
More than 1
 
Please list each child's full name, age, marital status & other biological parent's name. Please rate your relationship with each child from (1) Poor to (10) Excellent

 
 
 
137. Rate yourself as a parent. If no children or step-children select 0.
 
0. Not applicable
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
138. How would you rate your overall character versus other people in general?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
139. How would you rate your personal courage level overall?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
140. How would you rate your trustworthiness versus people in general?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
141. How would you rate your conscience?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
142. How would you rate your honesty and integrity overall?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
143. Overall, how would you rate your generosity?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
144. Overall, how would you rate your compassion and empathy for others?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
145. Overall, how well can you be counted on by others?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
146. How would you rate your willingness to help others?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
147. How do you rate yourself on selfless versus selfish?
 
1. Very self centered
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Very selfless
 
 
 
148. Overall, how would you rate yourself as a friend?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
149. Is your anger/temper an issue in your life?
 
1. A very big issue
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Not an issue at all
 
 
 
150. Is your alcohol consumption an issue in your life? If so, please describe briefly.
 
1. A very big issue now
 
2.
 
3. A very big issue in the distant past
 
4.
 
5. Somewhat of an issue now
 
6.
 
7. Somewhat of an issue in the distant past
 
8.
 
9. Never enough to be an issue
 
10. Never an issue at all
 
Please describe briefly

 
 
 
151. Is your non-alcohol substance abuse an issue in your life? If so, please describe briefly.
 
1. A very big issue now
 
2.
 
3. A very big issue in the distant past
 
4.
 
5. Somewhat of an issue now
 
6.
 
7. Somewhat of an issue in the distant past
 
8.
 
9. Never enough to be an issue
 
10. Never an issue at all
 
Please describe briefly

 
 
 
152. Have you had any DWI's or DUI's? If so, please describe briefly.
 
1. Yes, several and recently
 
2.
 
3. Yes, several and in the distant past
 
4.
 
5. Once recently
 
6.
 
7. Once in the distant past
 
8.
 
9.
 
10. Never
 
Please describe briefly including any accidents or injuries caused by your DWI/DUI.

 
 
 
153. Is your physical abuse of anyone an issue in your life?
 
1. A very big issue
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Not an issue at all
 
 
 
154. Have you ever physically harmed someone in your life except in self-defense? If so, please describe briefly
 
1. Yes, often and recently
 
2.
 
3. Yes, often in the distant past
 
4.
 
5. Yes, recently but infrequently
 
6.
 
7. Yes, infrequently in the distant past
 
8.
 
9. Never enough to be an issue
 
10. Never
 
Please describe briefly

 
 
 
155. Is your verbal or emotional abuse of anyone an issue in your life?
 
1. A very big issue
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Not an issue at all
 
 
 
156. Have you been physically abused? If so, please describe briefly.
 
1. Often in the recent past
 
2.
 
3. Infrequently in the recent past
 
4.
 
5. Often in the distant past
 
6.
 
7. Infrequently in the distant past
 
8.
 
9. Once in the distant past
 
10. Never
 
Please describe briefly

 
 
 
157. Have you been verbally or emotionally abused? If so, please describe briefly.
 
1. Often in the recent past
 
2.
 
3. Infrequently in the recent past
 
4.
 
5. Often in the distant past
 
6.
 
7. Infrequently in the distant past
 
8.
 
9. Once in the distant past
 
10. Never
 
Please describe briefly

 
 
 
158. Is your gambling an issue in your life?
 
1. A very big issue
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Not an issue at all
 
 
 
159. Is someone else's gambling an issue in your life? If so, please describe briefly.
 
1. A very big issue
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Not an issue at all
 
Please Describe Briefly

 
 
 
160. Has your breaking of laws been an issue in your life? If so, please describe briefly.
 
1. A very big issue now
 
2.
 
3. A very big issue in the distant past
 
4.
 
5. Minor issue recently
 
6.
 
7. Minor issue in the distant past
 
8.
 
9.
 
10. Never an issue at all
 
Please describe briefly

 
 
 
161. Has someone else's law breaking been an issue in your life?
 
1. A very big issue now
 
2.
 
3. A very big issue in the distant past
 
4.
 
5. Minor issue recently
 
6.
 
7. Minor issue in the distant past
 
8.
 
9.
 
10. Never an issue at all
 
 
 
162. Is your reckless spending an issue in your life? If so, please describe briefly.
 
1. A very big issue now
 
2.
 
3. A very big issue in the distant past
 
4.
 
5. Minor issue recently
 
6.
 
7. Minor issue in the distant past
 
8.
 
9.
 
10. Never an issue at all
 
Please describe briefly including the magnitude if a current issue
 
 
 
163. Is someone else's reckless spending an issue in your life?
 
1. A very big issue now
 
2.
 
3. A very big issue in the distant past
 
4.
 
5. Minor issue recently
 
6.
 
7. Minor issue in the distant past
 
8.
 
9.
 
10. Never an issue at all
 
Please describe briefly including the magnitude of the issue if current

 
 
 
164. Is your unemployment an issue in your life?
 
0. Not applicable - I am fully employed
 
1. A very big issue
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Not an issue at all
 
 
 
165. Is someone else's unemployment an issue in your life?
 
1. A very big issue
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Not an issue at all
 
Describe Briefly

 
 
 
166. Has your infidelity been an issue in your life? If so, briefly describe.
 
0. Not applicable - I have never engaged in infidelity
 
1. An issue recently in my life
 
2.
 
3. A recurring issue in my life
 
4.
 
5. A one time issue in my distant past
 
6.
 
7.
 
8.
 
9.
 
10. Not an issue at all
 
If so, Briefly Describe With Time Frame

 
 
 
167. Has someone else's infidelity been an issue in your life? If so, please describe briefly.
 
0. Not applicable - I am not aware of infidelity by a significant other or spouse
 
1. A recent issue
 
2.
 
3. A recurring issue in my life
 
4.
 
5. A one time issue in my life
 
6.
 
7.
 
8.
 
9.
 
10. Not an issue at all
 
If So, Briefly Describe With Time Frame

 
 
 
168. Is your dishonesty or untrustworthiness an issue in your life?
 
1. A very big issue
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Not an issue at all
 
 
 
169. Is someone else's dishonesty or untrustworthiness an issue in your life?
 
1. A very big issue
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Not an issue at all
 
 
 
170. How do you feel about tattoos on you?
 
1. Love them - I have many
 
2. Like them - I have a few
 
3. Maybe in the future
 
4. I have some that I wish were gone
 
5. No way ever
 
 
 
171. Please check any issues below that apply to you even if they are infrequent.

The goal is to identify issues to be addressed so be completely honest with yourself.

Note: Select the answers & Other if you want to add other issues
 
1. Character issues
 
2. Lack of conscience/compassion for others
 
3. Self-centered
 
4. Lazy
 
5. Shyness
 
6. Unmotivated
 
7. Dishonesty
 
8. Infidelity
 
9. Bad temper
 
10. Irresponsible
 
11. Alcohol or substance abuse
 
12. Gambling
 
13. Recklessness
 
14. Self-imposed limitations
 
15. Depression
 
16. Making excuses
 
17. Poor professional life judgment
 
18. Poor personal life judgment
 
19. Smoking
 
20. Law breaking
 
21. None of the above
 
Other

 
 
 
172. Are there things in your past that are adversely affecting your life today?
 
1. Many things
 
2.
 
3.
 
4.
 
5. Some things
 
6.
 
7.
 
8.
 
9.
 
10. Nothing
 
Describe briefly

 
 
 
173. Are there significant fear factors that affect your life?
 
1. Many
 
2.
 
3.
 
4.
 
5. Some
 
6.
 
7.
 
8.
 
9.
 
10. None
 
Describe Briefly

 
 
 
174. How would you rate yourself as a life partner?
 
0. Not applicable - I have never had a spouse or significant other
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
175. How would you rate yourself as a lover?
 
0. Not applicable - No experience
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
176. How would you rate yourself as a friend to your spouse or significant other? If no spouse or significant other now, please refer to your last previous relationship.
 
0. Not applicable - I have never had a spouse or significant other
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
177. How would you rate yourself as a social asset to a spouse or significant other?
 
0. Not applicable - I have never had a spouse or significant other
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
178. How would you rate yourself as a professional asset for a spouse or significant other?
 
0. Not applicable - I have never had a spouse or significant other
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
179. How would you rate yourself on affection and intimacy with a spouse or significant other?
 
0. Not applicable - I have never had a spouse or significant other
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
180. How would you rate yourself on trustworthiness with a spouse or significant other?
 
0. Not applicable - I have never had a spouse or significant other
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
181. How would you rate your general willingness to compromise in relationships?
 
0. Not applicable
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
182. How would you rate your willingness to consistently place your relationship with your spouse or significant above other concerns? If no spouse or significant other now, refer to your last previous relationship.
 
0. Not applicable - I never had a spouse or significant other
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
183. How would you rate your willingness to apologize and seek reconciliation after conflict?
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
184. How would you rate your willingness to let go of resentments?
 
0. Not applicable
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
185. Please rate your willingness to express your true thoughts and feelings and communicate with your spouse or significant other? If no spouse or significant other now, refer to your last previous relationship.
 
0. Not applicable - I have never had a spouse or significant other
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
186. Rate your ability to offer positive solutions to issues with your spouse or significant other and work to achieve permanent solutions. If no spouse or significant other now, refer to your last previous relationship.
 
0. Not applicable - I have never had a spouse or significant other
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
187. How would you rate your overall common interests and shared life priorities with your spouse or significant other? If no spouse or significant other now, refer to your last previous relationship.
 
0. Not applicable - I have never had a spouse or significant other
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
188. Rate how good you are at consistently making your relationship with a your significant other a top priority and honoring your commitments to them. If no spouse or significant other now, refer to your last previous relationship.
 
0. Not applicable - I have never had a spouse or significant other
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
189. Rate how reliable a source of support you are for your spouse or significant other. If no spouse or significant other now, refer to your last previous relationship.
 
0. Not applicable - I have never had a spouse or significant other
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
190. Rate how compatible your and your spouse or significant other's views of parenting are. If no spouse or significant other now, refer to your last previous relationship.
 
0. Not applicable - I have never had a spouse or significant other
 
1. Not compatible
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Very compatible
 
 
 
191. Overall, rate your compatibility with your spouse/significant other. If no spouse or significant other now, refer to your last previous relationship.
 
0. Not applicable - I have never had a spouse or significant other
 
1. Poor
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Excellent
 
 
 
192. Is sex a problem in your relationship with your spouse or significant other? If no spouse or significant other now, refer to your last previous relationship.
 
0. Not applicable - I have never had a spouse or significant other
 
1. A big problem
 
2.
 
3.
 
4.
 
5. Average
 
6.
 
7.
 
8.
 
9.
 
10. Not at all
 
 
 
193. How important is a good relationship with a spouse or significant other to your happiness?
 
1. Not important at all - I prefer being alone
 
2.
 
3. Not important enough to deal with all the issues
 
4.
 
5. Very important - I do not like to be alone
 
6.
 
7. Important but I am too busy now with other things
 
8.
 
9. Important but not necessary
 
10. Very important but it has to be with someone very special
 
 
 
194. How would you describe your romantic nature?
 
1. Romance? Are you kidding me?
 
2.
 
3. Romance is a dead notion of a bygone era
 
4.
 
5. Romance is okay but it never lasts
 
6.
 
7. Romance is important to me but I never see it
 
8.
 
9. Romance is important to me and can be very enjoyable
 
10. Romance that endures is important to a successful intimate relationship
 
 
 
195. Where is sex on your list of priorities? Select more than 1 choice if applicable.
 
0. Not applicable
 
1. Sex is a means to get what I want
 
2. I do not like sex
 
3. Sex is great but desire is hard for me to sustain with one person
 
4. Sex is way overrated
 
5. Sex is okay but not that important to me
 
6. Sex is great and very important to me
 
7. Sex is important but a lot of other things are more important to me
 
8. Sex is important to me but only in a committed intimate relationship
 
9. Good sex is an important way to express affection
 
10. Good sex is an important element in an enduring relationship
 
Comment if you want to

 
 
 
196. Please rate your personal happiness among your overall life priorities.
 
1. Very low priority
 
2.
 
3.
 
4.
 
5. Important
 
6.
 
7.
 
8.
 
9.
 
10. Very high priority
 
 
 
197. Please rate your significant other's happiness among your overall life priorities.
 
0. Not applicable
 
1. Very low priority
 
2.
 
3.
 
4.
 
5. Important
 
6.
 
7.
 
8.
 
9.
 
10. Very high priority
 
 
 
198. Please rate your relationship with your spouse or significant other among your life priorities.
 
0. Not applicable
 
1. Very low priority
 
2.
 
3.
 
4.
 
5. Important
 
6.
 
7.
 
8.
 
9.
 
10. Very high priority
 
 
 
199. Please rate your children's happiness among your overall life priorities at his point in your lives.
 
0. Not applicable
 
1. Very low priority
 
2.
 
3.
 
4.
 
5. Important
 
6.
 
7.
 
8.
 
9.
 
10. Very high priority
 
 
 
200. Please rate your career among your overall life priorities.
 
1. Very low priority
 
2.
 
3.
 
4.
 
5. Important
 
6.
 
7.
 
8.
 
9.
 
10. Very high priority
 
 
 
201. Please rate material things among your life priorities.
 
1. Very high priority
 
2.
 
3.
 
4.
 
5. Important
 
6.
 
7.
 
8.
 
9.
 
10. Very low priority
 
 
 
202. Please rate friends among your life priorities.
 
1. Very low priority
 
2.
 
3.
 
4.
 
5. Important
 
6.
 
7.
 
8.
 
9.
 
10. Very high priority
 
 
 
203. Most people have elements of more than one personality profile so please select the personality traits that apply to you to some degree.

Then rate the items you chose with a percentage that applies to you for each choice you made to reach a total of 100% for all traits.
 
A. Type “A” Personality - Leaders - Entrepreneurial, risk takers, direct, innovative, self-motivated, dislike routine, enjoy change, focused, decisive, persistent, and can be insensitive and impatient. Socially functional because it is a necessity to reach their ambitions, but can turn off other people. Rely on their intellect, leadership qualities and knowledge to succeed. Achieving success is very important.
 
B. Type “B” Personality - Socially oriented – Love excitement and to party and travel, enjoy groups, like being center of attention, supportive of friends, want to be liked by others and easily hurt if rejected, good public speakers, talkative, personable, persuasive, outgoing extroverts. Rely more on their personalities than their expertise to succeed. Tend to think more emotionally than rationally. Enjoying life is very important.
 
C. Type "C" Personality - Artistic and creative oriented - Usually fashionable or flaky dressers. Enjoy expressing their active imaginations through writing or other artistic expression. Socially interesting but can be reserved. Tend to think more emotionally than rationally. Often have difficulty with analytical thinking and mathematics. Rely on their artistic talents to succeed. Expressing themselves through their art is very important.
 
D. Type “D” Personality - Detail and analytically oriented – Precise, organized, consistent, predictable, responsible, thoughtful, slow to make decisions, emotionally sensitive, inquisitive, loyal, and patient. Think more rationally than emotionally. Rely on their expertise to succeed. Can struggle in social settings. Understanding the details is very important.
 
E. Type “E” Personality - Status quo lovers – Dislike change, prefer the predictable, enjoy repetitive tasks, security oriented, compassionate of others, happy, punctual and content. Rely on consistent conformity to succeed. Preparing for a great retirement is very important.
 
F. Type “F” Personality - Underachievers – Can be very bright, but low self-esteem and/or motivation are obstacles to their life potential. Inward focused and prefer to settle for less in life rather than to aspire for more and have to face the potential for failure. Rely on low self-expectations to avoid dealing with success. Avoiding competition and accountability is very important.
 
G. Type “G” Personality - Self destructive – Reject societal expectations, and engage in self-destructive behavior without concern for the adverse effects on their life potential. Every problem they have is someone else’s fault. Success is being a non-conformist. Doing whatever they want is very important.
 
List a percentage of each personality type that applies to you to total 100%:

 
 
 
204. Where would you rate yourself on the political spectrum?
 
1. Very Liberal
 
2. Liberal
 
3. Independent
 
4. Moderate
 
5. Conservative
 
6. Very Conservative
 
7. Libertarian
 
8. I do not care about politics
 
 
 
205. How concerned are you about political outcomes in 2012?
 
1. Not concerned at all
 
2.
 
3.
 
4.
 
5. Concerned
 
6.
 
7.
 
8.
 
9.
 
10. Extremely concerned
 
 
 
206. Comments/Suggestions:
   
 
 
 
207. Please release this completed questionnaire to the following person(s) at the listed e-mail address(es):
   
 
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