Sample Questionnaire

Age: 20 and under □ 21-30 □ 31-40 □ 41 and over □

Gender: Male □ Female □

Educational Level: Undergraduate □ Postgraduate □
Faculty: Engineering □ Humanities and Education □
Medical Sciences □ Science and Agriculture □
Social Sciences □
Instructions: Answer the following questions based on the following scale :

Strongly Agree Neutral Disagree Strongly

Agree Disagree

1.Do you feel other members’ opinions within a group are equally important as
yours?.........................................................................................................................□ □ □ □ □

2.It is important to have a leader in a group.............................................................. □ □ □ □ □

3.Based on my competencies I expect preferential treatment from others………… □ □ □ □ □

4.It is necessary to consider others needs and feelings…………………………….. □ □ □ □ □

5.Do you feel a sense of remorse when others are harmed?...................................... □ □ □ □ □

6.Are you critical of others?....................................................................................... □ □ □ □ □

7.I am able to take criticism………………………………………………………….□ □ □ □ □

8.Do you accept responsibility for failure?..................................................................□ □ □ □ □

9.Do you tend to be controlling?..................................................................................□ □ □ □ □

10.Do find your self dismissing other opinions?..........................................................□ □ □ □ □

11.I often hide my needs for fear that others will see me as needy and dependent?... □ □ □ □ □
12.Are you prone to painful feelings of emptiness…………………………………...□ □ □ □ □

13.Do you tend to feel misunderstood, mistreated or victimized?...............................□ □ □ □ □

Strongly Agree Neutral Disagree Strongly
Agree Disagree

14.I cannot stand relying on other people because it makes me feel weak………….□ □ □ □ □

15.Sometimes I avoid people because I am concerned they would not acknowledge

what I do for them………………………………………………………………...□ □ □ □ □

16.When others don’t notice me I start to feel bad about my self…………………...□ □ □ □ □

17.Do you tend to feel inferior to others?...................................................................□ □ □ □ □

18.Do you often experience feelings of unhappiness?...............................................□ □ □ □ □

19.I often fantasize about accomplishing things that are probably beyond
my means?.............................................................................................................□ □ □ □ □

20.I am frequently preoccupied with past thoughts and concerns…………………..□ □ □ □ □

21.Do you take pleasure in accomplishing goals?......................................................□ □ □ □ □

22.I consider myself energetic………………………………………………………□ □ □ □ □

23. I consider myself outgoing……………………………………………………...□ □ □ □ □

24.Based on my talents and abilities I am productive and effective………………..□ □ □ □ □

25.When necessary I am able to assert myself effectively and appropriately………□ □ □ □ □

26.I often fantasize about having a huge impact on the world around me…………..□ □ □ □ □

27.I believe I can talk my way out of any situation………………………………….□ □ □ □ □

28.I find it easy to manipulate people………………………………………………..□ □ □ □ □

29.I am comfortable and at ease in social situations…………………………………□ □ □ □ □

30.I think it is appropriate to use my sexuality to accomplish goals………………....□ □ □ □ □

Thank you for your participation!