Mindful of Nature - Participant Survey
Adult Participants
Sign in to Google to save your progress. Learn more
1. The date the program started in the format MMDDYY (Read description.) *
If this is a multi-day workshop, enter the day of the first workshop for both surveys. (For example, January 02, 2001 = 010201)
2. The Lead Teacher's Initials *
This needs to be the same for all Before/After data pairs for the participants, so please use only one teacher's set of initials for both the before and after surveys. The teacher will decide who is the "lead" teacher when the program has more than one teacher.
3. Enter the month and day of your birth in the format MMDD: *
For example, if you were born on January 7th please enter 0107
4. Enter first 3 characters of your current (or most recent) street address: *
For example, If participant address is 21st Ave, please enter 21S. For Springfield Rd, please enter SPR
This answer needs to be the same both times the survey is taken.
5. Survey taken Before / After the program offering. *
6. Select your age range: *
Pick one age range.
7. Select your gender: *
8. Do you live alone? *
With other humans?
9. Do you have a pet? *
10. How much experience do you have with mindfulness/meditation? *
None
A Lot
11. How much experience do you have with nature-based mindfulness/meditation? *
None
A Lot

In this moment, how much do you agree with the following statements?

1. I feel a sense of oneness with the natural world around me.

*
Strongly Disagree
Strongly Agree
2. I can’t stop or control my worrying. *
Strongly Disagree
Strongly Agree

3. I feel part of the web of life.

*
Strongly Disagree
Strongly Agree

4. My personal welfare is independent of the welfare of the natural world.

*
Strongly Disagree
Strongly Agree

5. I’m feeling restless — it’s hard to sit still.

*
Strongly Disagree
Strongly Agree

6. I feel easily annoyed or irritable.

*
Strongly Disagree
Strongly Agree

7. I feel disconnected from nature.

*
Strongly Disagree
Strongly Agree

8. I feel a kinship with animals and plants.

*
Strongly Disagree
Strongly Agree

9. I think of the natural world as a community to which I belong.


*
Strongly Disagree
Strongly Agree

10. I recognize and appreciate the intelligence of other living organisms.

*
Strongly Disagree
Strongly Agree

11. I’m afraid something awful might happen.

*
Strongly Disagree
Strongly Agree

12. When I think of my life, I imagine myself to be part of a larger cyclical process of living.

*
Strongly Disagree
Strongly Agree
13. I feel nervous, anxious, or on edge. *
Strongly Disagree
Strongly Agree

14. I feel as though I belong to the Earth as equally as it belongs to me.

*
Strongly Disagree
Strongly Agree

15. I have a deep understanding of how my actions affect the natural world.

*
Strongly Disagree
Strongly Agree

16. I’m worrying too much about different things.


*
Strongly Disagree
Strongly Agree

17. I feel that all inhabitants of Earth, human, and nonhuman, share a common “life force.”

*
Strongly Disagree
Strongly Agree

18. Like a tree can be part of a forest, I feel embedded within the broader natural world.

*
Strongly Disagree
Strongly Agree

19. When I think of my place on Earth, I consider myself to be a top member of a hierarchy that exists in nature.

*
Strongly Disagree
Strongly Agree

20. I feel like I am only a small part of the natural world around me, and that I am no more important than the grass on the ground or the birds in the trees.

*
Strongly Disagree
Strongly Agree

21.  I’m having trouble relaxing.

*
Strongly Disagree
Strongly Agree

22. How relevant do you think the lessons from today are for your life - what was most relevant?

*

23. What do you hope to remember from today’s experience?

*
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Gary Sharlow Workspace.

Does this form look suspicious? Report