Questionnaire.docx

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

Agree Disagree

Strongly disagree

Strongly Agree

Agree Disagree

Strongly 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 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 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.

Strongly Agree

Agree Disagree

Strongly disagree