1. Take a look at yourself as you read the following statements. Be as honest as possible because all this is anonymous.

Please evaluate the following comments as to whether you Totally Disagree (TD), Disagree (D), Agree (A), or Totally Agree (TA).

	TD	D	A	TA
I am confident that I will be a capable and productive adult.
I am able to perform well under pressure.
I have good goals and a plan to pursue them.
I feel very comfortable interacting with people I know.
I feel very comfortable interacting with strangers.
I make friends very easily.
I am comfortable speaking before groups of people.
I can form well-reasoned opinions on a variety of subjects.
I can express myself with confidence and clarity.
I easily assume a leadership role in small groups.
I routinely make good choices.

2. Think of people that you admire and the qualities that you find admirable. These people can be adults or other teenagers. Comment on the following statements and how important they are to your respect and admiration of them.

Please evaluate the following comments as to whether you Totally Disagree (TD), Disagree (D), Agree (A), Totally Agree (TA).

I tend to admire and respect people who are or have ...

	TD	D	A	TA
... lots of friends and are very comfortable with other people.
... cool clothes and drive nice cars.
... always seeming to know just what to do.
... pretty or handsome.
... athletic or especially gifted in some area like art, dancing, music, etc.
... good students.
... good listeners.
... trustworthy and dependable.
... smooth talking and glib.
... quite and reserved.
... the ability to handle themselves well under pressure.

3. There are characteristics that successful people seem to have. Please evaluate each of the following phrases as to their importance to success. Please indicate your choice of Not At All Imporant (NAAI), Not Very Important (NVP), Somewhat Important (SI), or Very Important (VI).

Evaluate each of the following as instructed above:

	NAAI	NVI	SI	VI
Being handsome or pretty
Good clothes
Good grooming
Having money
Being honest
Being dependable
Being responsible for own actions
Attending church or synagogue
Having a strong sense of right and wrong
Responding well under pressure
Self-control
Tolerance
Self-confidence
Aggressive and domineering
Willing to help others
Sensitive
Always right
Mentally powerful
Physically powerful
Socially powerful

Tell us something about yourself.

4a. I am (select one)

Female
Male

4b. My age is (select one)

Under 13
14 - 16
17 - 18
19 - 21
Over 21

4c. I live in (select one)

a small town or rural setting
a medium sized town
a small city
a large city

4d. I am (select all that apply)

an only child
one of 2 or 3 children
one of more than 4 children
a twin or triplet
living with a single parent
living with both parents
living with neither parent
adopted
living in a blended family

Thank you for taking the time to complete this survey. Select Submit now to send your responses to us.

This questionnaire was created by Perseus SurveySolutions for the Web.