Questionnaire, Clean Draft 3, 9.11.09
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- Pages: 3
Silhouettes/Dress for Success Partnership Questionnaire for Potential Participants ABOUT YOU (Please fill out as much as applies to you) 1. First Name
Middle Initial
Last Name
2. Home Address Number and Street
Apt.
City 3. Home phone
(
State
Cell phone (
)
4. Daytime phone number
Zip Code
(
)
)
5. Email address MORE ABOUT YOURSELF 1. Your Age (circle one)
18-25
26-30
31-35
36-40
2. Marital Status (circle one)
Single
Married
Divorced
Widowed
3. Highest education level (circle one)
High school or equivalent
4. Are you currently working?
Yes
41-45
Some college
46-50
51-55
56+
College degree
No
5. Occupation (even if not currently working) 6. What are your favorite TV shows?
7. What are some things you like to do in your spare time?
ABOUT YOUR FAMILY 1. Do you have children (under age 25) living in your household? (circle one) 2. Number of children living in your household (circle one)
Yes
No
None
1
2
______ 15-18
______ 19-25
3. Age of children living in your household Number of children in each age range
______ None
______ Infant to 5
______ 6-10
Page 1 of 3
______ 11-14
3
4 or more
COMPUTER, WEB AND WORK RELATED 1.
About how often do you use a computer? (circle one) Several times/day
Several times/week
Once a week or less
Do not use a computer on a regular basis 2.
If you use a computer on a regular basis, is your computer usage mostly for work, home or a mix? (circle one) Mostly at work
Mostly at home
Mix of work and home
Other (please describe) 3.
Do you or your family have your own computer? (circle one) Yes
4.
If no, where do you access the internet? (circle all that apply) At work
5.
At home
At home
9.
At library
At friend or relative's house
3-4 hours/week
5+ hours/week
Are you active on any social networks (for example: Myspace, Facebook, Twitter, etc.)? (circle one) Yes
8.
At friend or relative's house
In an average week, excluding time at work, about how much time do you spend on the internet? (circle one) 0-2 hours/week
7.
At library
If you checked more than one, where do you most often access the internet? (circle only one) At work
6.
No
No
If yes, please circle all that you use. Myspace
Facebook
Twitter
LinkedIn
Classmates.com
Other
Flickr
How comfortable are you in potentially sharing your thoughts and experiences online, as they relate to Dress for Success, your job and/or your job search, etc.? (circle one) Very comfortable
Somewhat comfortable
Comfortable
Not very comfortable
Not comfortable 10. How
do you feel about your work and what you are able to contribute to your colleagues and your company? (If not currently working, skip to #11)
Page 2 of 3
COMPUTER, WEB AND WORK RELATED 11.
If you're not currently working, are you comfortable with sharing your thoughts and feelings about this? (circle one) Very comfortable
Somewhat comfortable
Comfortable
Not very comfortable
Important
Not important
Not comfortable
12.
How important is building a career to you? (circle one) Very important
13.
Somewhat important
Have you identified what type of career you aspire to achieve? Yes Please describe the type of career No
14. Do
you enjoy writing? (circle one) Yes
Somewhat
No
15. Is
there anything else you would like to add about yourself and why you want to participate in the Silhouettes/Dress for Success partnership project?
ABOUT YOUR EXPERIENCES WITH DRESS FOR SUCCESS AND THE PROFESSIONAL WOMEN'S GROUP 1.
In your own words, how has Dress for Success helped you? Please write as much as you would like.
2.
What advice would you give someone who's unsure about becoming a client of Dress for Success?
3.
How has the Professional Women's Group helped you?
THANK YOU!
Page 3 of 3
Middle Initial
Last Name
2. Home Address Number and Street
Apt.
City 3. Home phone
(
State
Cell phone (
)
4. Daytime phone number
Zip Code
(
)
)
5. Email address MORE ABOUT YOURSELF 1. Your Age (circle one)
18-25
26-30
31-35
36-40
2. Marital Status (circle one)
Single
Married
Divorced
Widowed
3. Highest education level (circle one)
High school or equivalent
4. Are you currently working?
Yes
41-45
Some college
46-50
51-55
56+
College degree
No
5. Occupation (even if not currently working) 6. What are your favorite TV shows?
7. What are some things you like to do in your spare time?
ABOUT YOUR FAMILY 1. Do you have children (under age 25) living in your household? (circle one) 2. Number of children living in your household (circle one)
Yes
No
None
1
2
______ 15-18
______ 19-25
3. Age of children living in your household Number of children in each age range
______ None
______ Infant to 5
______ 6-10
Page 1 of 3
______ 11-14
3
4 or more
COMPUTER, WEB AND WORK RELATED 1.
About how often do you use a computer? (circle one) Several times/day
Several times/week
Once a week or less
Do not use a computer on a regular basis 2.
If you use a computer on a regular basis, is your computer usage mostly for work, home or a mix? (circle one) Mostly at work
Mostly at home
Mix of work and home
Other (please describe) 3.
Do you or your family have your own computer? (circle one) Yes
4.
If no, where do you access the internet? (circle all that apply) At work
5.
At home
At home
9.
At library
At friend or relative's house
3-4 hours/week
5+ hours/week
Are you active on any social networks (for example: Myspace, Facebook, Twitter, etc.)? (circle one) Yes
8.
At friend or relative's house
In an average week, excluding time at work, about how much time do you spend on the internet? (circle one) 0-2 hours/week
7.
At library
If you checked more than one, where do you most often access the internet? (circle only one) At work
6.
No
No
If yes, please circle all that you use. Myspace
Classmates.com
Other
Flickr
How comfortable are you in potentially sharing your thoughts and experiences online, as they relate to Dress for Success, your job and/or your job search, etc.? (circle one) Very comfortable
Somewhat comfortable
Comfortable
Not very comfortable
Not comfortable 10. How
do you feel about your work and what you are able to contribute to your colleagues and your company? (If not currently working, skip to #11)
Page 2 of 3
COMPUTER, WEB AND WORK RELATED 11.
If you're not currently working, are you comfortable with sharing your thoughts and feelings about this? (circle one) Very comfortable
Somewhat comfortable
Comfortable
Not very comfortable
Important
Not important
Not comfortable
12.
How important is building a career to you? (circle one) Very important
13.
Somewhat important
Have you identified what type of career you aspire to achieve? Yes Please describe the type of career No
14. Do
you enjoy writing? (circle one) Yes
Somewhat
No
15. Is
there anything else you would like to add about yourself and why you want to participate in the Silhouettes/Dress for Success partnership project?
ABOUT YOUR EXPERIENCES WITH DRESS FOR SUCCESS AND THE PROFESSIONAL WOMEN'S GROUP 1.
In your own words, how has Dress for Success helped you? Please write as much as you would like.
2.
What advice would you give someone who's unsure about becoming a client of Dress for Success?
3.
How has the Professional Women's Group helped you?
THANK YOU!
Page 3 of 3
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