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1.
Please list your first name and email address
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2.
What is your age?
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3.
Please describe your ethnicity?
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4.
Please indicate your marital status
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5.
Please list your religious affiliation?
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6.
Please list the age(s) and gender of your child(ren)
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7.
What is your approximate household income?
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8.
Think about your mother and father’s relationship. Were they married, dating, living together, etc? And how long were or have they been together?
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9.
Describe your parent’s relationship using only one of the following words: appropriate, fun-loving, abusive, detached, unhealthy or non-existent.
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10.
Describe your relationship with your father using one of the following words
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11.
Please list one memorable moment you had with your father as a child
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12.
How do you think your relationship with your father has impacted your relationship with other men?
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13.
When directly involved in a project, I feel anxious if all aspects of it are not adequately managed:
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14.
I can quickly identify the source of the problem in circumstances whether I am directly or indirectly involved:
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15.
Is it difficult for me to say “no” to people when I am asked to do something, even if I don’t have time to fit their request into my schedule:
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16.
When I see an injustice occurring, my first response is to look the other way and not get involved:
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17.
I admit that when I am around people that don’t know me well, without changing the basics of my identity, I portray or act like someone that I think is more exciting and interesting:
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18.
I feel best when I am in an administrative role in the projects that I am involved in:
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19.
When someone identifies me as being the “weak link” in a crisis situation, my first response is to get upset and lash out at them:
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20.
I feel overwhelmed by my commitments to career, family, church/social duties:
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21.
I find it hard to speak out about issues even if I am passionate about them:
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22.
I spend more than 2 hours a day watching television, excluding news program:
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23.
I feel in most situations that I am the best person for the job, even when I am not the most qualified:
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24.
I complain about my job/career:
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25.
If interviewed individually and privately, my close friends would divulge that I am an indecisive person:
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26.
I’ve changed jobs or careers solely because I found it difficult to get along with my boss:
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27.
When I think about past relationships with men, I find myself very disappointed, let down and depressed:
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28.
I am extremely competitive in every arena in my life:
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29.
I respond in similar ways to constructive and destructive criticism directed towards me:
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30.
I feel it necessary to keep exciting life experiences fresh in my mind so that I can share them with people who don’t know me well.
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31.
I feel like my close friends don’t understand the real me:
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32.
I allow myself to think about being extremely famous, popular and wealthy when things in my life don’t go the way I expected:
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33.
I can easily justify my feelings, emotions and responses in the relationships I am involved in:
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34.
I am easily offended when an incident occurs involving me and someone else is at fault:
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35.
I put other people’s feelings above my own:
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36.
Is it easy for me to leave a project unfinished?
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37.
I can describe in intricate detail favorable and unfavorable incidents in my life:
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