Self-Assessment
Answer a few questions about yourself.
Your anonymous results will be used in a statistical report.

The more responses we receive, the more accurate the data will be, so please pass this on!
Take the Survey
 
What is your gender? *


 
What is your age? *


 
What is your marital status? *


 
What is your ethnicity? *


 
What is your income level? *


 
Do you earn the most money in your household? *

     
 
If you do not earn the highest income in your household, who does?

No names - just relationships.  You may share the amount they earn. Press the down arrow to skip this question.
 
Do you have any children? *

     
 
If you have children, how many do you have?

Press the down arrow to skip this question.
 
How often do you feel optimistic? *

 
How often do you feel pessimistic? *

 
How often do you feel lovable? *

 
How often do you feel confident? *

 
How often do you feel insecure? *

 
How often do you feel valuable? *

 
How often do you feel depressed? *

 
How often do you feel content or fulfilled? *

 
How often do you feel useful? *

 
How often would you like to have sex? *

 
Who is more important to you? *

 
Are you intelligent? *

     
 
Are you physically strong? *

     
 
Are you funny? *

     
 
In general, do people listen when you speak? *

     
 
Do you get interrupted often while speaking? *

     
 
Who do you prefer talking with? *


 
Which gender do you think has contributed more to society? *


 
What are your top 3 strengths? *

 
What are your top 3 areas for improvement? *

 
Here is your chance to share any additional information you think relevant.

Press down to skip this question.
 
Thank you very much for your honest participation!

Please share this survey with everyone you know. The more responses we receive, the more accurate the data will be.
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