CWO 1 Survey Questionnaire: Self-esteem
Email address
Name of Interviewee
Your answer
Date
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Your answer
Name of Interviewer
Your answer
I feel that I am a person of worth, at least on an equal plane with others.
Completely disagree
Completely agree
I am able to do things as well as most people.
Completely disagree
Completely agree
I am proud of my work in general.
Completely disagree
Completely agree
I am fun to be with.
Completely disagree
Completely agree
I do not care about others’ opinion on my physical appearance.
Completely disagree
Completely agree
I feel that I have a number of good qualities.
Completely disagree
Completely agree
On the whole, I am satisfied with myself.
Completely disagree
Completely agree
I feel I do not have much to be proud of.
Completely disagree
Completely agree
I wish I could have more respect for myself.
Completely disagree
Completely agree
I certainly feel useless at times.
Completely disagree
Completely agree
I feel a sense of worthiness about myself by having the ability to participate in the program.
Completely disagree
Completely agree
I recognize that I am a capable person when I interact with people in the program.
Completely disagree
Completely agree
I feel my work is valuable when it is shared and commented by others in the program.
Completely disagree
Completely agree
I find myself sociable when I am in the program.
Completely disagree
Completamente de acuerdo
I gain confidence rather than disappointment regarding my own physical appearance when I reveal myself in the program.
Completely disagree
Completely agree
In general, how confident do you feel about your abilities to carry out a work that is assigned to you? Please provide a brief example based on your past experience supporting your thoughts.
Your answer
When you think that some of the people you meet might have an unfavorable opinion of you, are you concerned or not concerned about it? Please describe how you respond to such situations (your actions, your inner thoughts, etc.).
Your answer
Are you bothered by others’ comments about your physical appearance? Please describe why you think in such a way you answered.
Your answer
Does your participation in the program help you present and get valuable feedback for your capabilities in carrying out your work? Why or why not? What was your general emotional experience from the feedback?
Your answer
Does your participation in the program influence how you regard yourself vis-à-vis others in terms of the level of achievement in life? Why or why not?
Your answer
Does your participation in the program influence how you regard yourself vis-à-vis others in terms of physical appearance? Why or why not?
Your answer
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