EnvironmentalSurvey- NEPRINTAT

EnvironmentalSurvey- NEPRINTAT - ENVIRONMENTAL SENSITIVITY:...

Info iconThis preview shows pages 1–3. Sign up to view the full content.

View Full Document Right Arrow Icon
ENVIRONMENTAL SENSITIVITY: A SURVEY INVESTIGATION OF HUMAN FACTORS This survey is intended to glean information concerning factors in a person’s background and his/her likelihood to be particularly “sensitive” in some way. Please answer honestly and matter of factly. While the nature of this survey makes it necessary to ask some rather personal questions, please know that your responses will be combined with those of other anonymous respondents – and kept confidential. Completed surveys should be mailed to the survey’s author, Michael Jawer, at 8624 McHenry Street, Vienna VA 22180. If you have any questions, please email mjawer2001@yahoo.com . Thank you very much for participating. _________________________________________________________________ 1) Your age: ____ (years) 2) Gender: Male ____ Female ____ 3) Are you currently (check one): Married ____ Divorced or separated ____ In long-term partnership ____ Single; never married ____ Widowed ____ 4) Do you have children? (biological, not adopted) Yes ____ No ____ 5) If so, what are their ages and genders? Child one: age ______ M ____ or F ____ Child two: age ______ M ____ or F ____ Child three: age ______ M ____ or F ____ Child four: age ______ M ____ or F ____ Child five: age ______ M ____ or F ____ Child six: age ______ M ____ or F ____ 6) Highest educational level attained (check one): Some high school ____ College graduate ____ High school graduate ____ Post graduate work ____ Some college ____ Graduate degree(s) ____ 7) Height: ____ feet ____ inches 8) Weight: _____ pounds
Background image of page 1

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
How would you describe your body type? Please mark one of the numbers below: T h i n W i d e __________________________________________________________________ 1 2 3 4 5 10) Are you right-handed? _____ Left-handed? ____ or Ambidextrous? ____ 11) How would you describe your tendency toward imagination? Please mark one of the numbers below: Think Literally Think Imaginatively __________________________________________________________________ 1 2 3 4 5 12) How would you describe your ‘native’ temperament? Please mark one of the numbers below: Inward Looking Outward Looking __________________________________________________________________ 1 2 3 4 5 13) How would you describe your emotional style (when relating to others)? Please mark one of the numbers below: R e s t r a i n e d E m o t i v e __________________________________________________________________ 1 2 3 4 5 14) Please note your interests or hobbies below: (list up to 4) Hobby or interest one: _____________________________________________ Hobby or interest two: _____________________________________________ Hobby or interest three: _____________________________________________ Hobby or interest four: _____________________________________________ 15) Do you play a musical instrument or do you engage in artistic creation? Yes, extensively ____
Background image of page 2
Image of page 3
This is the end of the preview. Sign up to access the rest of the document.

This document was uploaded on 03/06/2011.

Page1 / 10

EnvironmentalSurvey- NEPRINTAT - ENVIRONMENTAL SENSITIVITY:...

This preview shows document pages 1 - 3. Sign up to view the full document.

View Full Document Right Arrow Icon
Ask a homework question - tutors are online