Male or Female:____________
Does your school require you to complete a minimum of community service hours? If yes, how many?
Do you participate in volunteering or community service outside of school requirements? If yes, how many hours per week? ____________________________________________________________
Instructions. This is a questionnaire about young people’s behavior, thoughts, and feelings in groups. Try to imagine yourself in the given situations. Check the response that best describes how you would honestly react. Don’t spend too long on any one question; there is no right or wrong answer.
1. If you see two people talking and casually glancing your way, do you: ____ Feel sure they’re talking about you?
____ Think that it’s probably coincidence?
____ Check to see that you don’t look odd in any way?
2. Imagine that you and your friends are trying out a new dance at a party. It is turned into a competition and you reach the finals. Do you: ____ Feel silly because you don’t think you’re very good? ____ Try to perfect all the steps?
____ Wonder what others think of your dancing?
3. If on arrival at a party, you found a grease patch on your jeans, would you: ____ Not worry?
____ Go home because you think that everyone would notice? ____ Go home because you don’t feel right when you’re dirty?
4. If you got “tipsy” at a party and ended up dancing on a table, in front of everyone, how would you feel the next day? ____ A little nervous because you’d think everyone would mention it? ____ Uncomfortable because you don’t like acting the fool? ____ No different, you’d forget it?
5. If you were suddenly asked to present a paper to the class, would you: ____ Be uncomfortable because you thought others were evaluating you? ____ Feel bad because you couldn’t present your best work in the short time available? ____ Not worry too much about it?
6. If you arrive late for a meeting, do you:
____Try to come in the back way because you think that everyone’s eyes will be on you? ____ Come in as unobtrusively as possible?
____ Feel bad for interrupting the meeting?
7. You are against uranium mining and asked to lead a demonstration. Would you: ____ Decline because you’d feel shy being at the front? ____ Decline because you think your friends would call you a “radical”? ____ Accept without a moment’s thought?
8. While opening a meeting, you accidentally spill something on a guest speaker. Is your first reaction to: ____ Think how clumsy everyone will think you are?
____ Feel embarrassed about the mess you’ve made?
____ Hope that it won’t leave a stain?
9. When you’re at a party and talking to someone of the opposite sex, do you: ____ Not act different than normal?
____ Usually feel shy and self-conscious?
____ Wonder what others are thinking about the two of you?
10. It is the premiere of a film made by your school in which you played the lead role. What is your main concern: ____ That you don’t come across as well on film as on stage? ____ That everyone will think that you were not really suited to the part? ____ That the film goes well and will be a credit to your school?
11. If you and a group of friends arranged to meet at a coffee shop and you arrived first, you would: ____ Think that everyone was looking at you and wondering why you were there? ____ Order a coffee while you were waiting?
____ Feel uncomfortable because you were alone?
12. You drop your knife with a loud clatter in a restaurant. Do you: ____ Imagine that everyone turned to see who made the noise? ____ Feel a fool for being so clumsy?
____ Pick it...