| Gender | Male |
| Female |
| Age | |
| MBTI Type | |
| Enneagram | |
| Did you attend Church or belong
to a specific religious teaching during your childhood? | Yes, I attended a church |
| Yes, but I did not attend church |
| My family was more spiritual than religious |
| No,
None |
| What natural environment did
you live in for the MAJORITY of your childhood? | I lived in a big city! I knew my way around and could take care of
myself |
| I lived in the city limits of a small town where everyone knew everyone! |
| I lived in a very rural location - Bugs and Trees were my companions |
| I lived in a medium sized city or suburb |
| What income level did you
perceive that your family lived at when you were a child? | I never heard my parents discuss any financial difficulties, I believe
we had plenty of money for what we needed |
| Money was always tight but we did OK |
| Everything was a struggle for our family with money |
| We lived an average income. Not rich, but not floundering either |
| What birth-order are you among
siblings? | I am an only child |
| I have siblings, but they were not in the household or are much older |
| I am an eldest child |
| I am a middle child |
| I am the youngest child |
| Up to the age of 18 the status
of my parents relationship was: | My parents were married |
| My parents were married but I suspect(ed) they were/are miserable |
| My parents separated but weren't divorced |
| My parents were divorced |
| Were both of your parents
in your life through age 18? | Yes, both of my parents were active in my childhood |
| One or both of my parents were deceased before I was 18 |
| One or both of my parents abandoned me or our family |
| I was adopted and felt loved and safe |
| I was adopted and wondered about my real parents a lot/felt abandoned |
| Were you witness to or victim
of abuse as a child? | Yes, Emotional |
| Yes, Physical |
| Yes, Sexual |
| Yes, more than one of these |
| No |
| How much exposure to drugs
did you have as a child? | I was never aware of drugs in our home |
| At least one person in my home used drugs that I knew of (not counting myself) |
| How much did you experiment
with illegal drugs as a child? | I never experimented with drugs |
| I experimented with friends (Cigarettes, Marijuana, Drinking) but nothing serious |
| I
used drugs beyond normal 'curiosity' or peer pressure (Cocaine, Heroine, Meth, Etc) |
| How much supervision did you
have as a child/teen? | I could go wherever, whenever without repurcussion. My guardians never knew or cared where
I was |
| I had reasonable privileges and restrictions for my age |
| I was overly restricted and supervised |
| I had freedoms based on earned trust and honesty |
| How much responsibility did
you have as a child? | I had many responsibilities that I was required to fulfill |
| I had normal tasks and responsibilities normal for a child |
| I had no responsibilities |
| I had many responsibilities that I sought out and enjoyed |
| What is your highest level
of education? | College Degree or higher |
| Some College |
| High
School Diploma |
| GED |
| Did not graduate |
| Do you consider yourself a
'lifelong learner' | Yes |
| No |
| What kind of student are/were
you? | High Honor Student |
| Honor
Student |
| Average Grades |
| Normall Just Squeaked By |
| Failed occasionally or re-took classes/grade levels |
| How big of a role does music
play in your life? | Music is a part of my soul, I can't live without it |
| I enjoy music but not really passionate about it |
| I don't really care for music that much |
| Do you enjoy reading? | I
love to read all kinds of books and genres |
| I read mostly Non-Fiction as a way of learning |
| I read mostly Fiction and love to escape to new worlds |
| I read magazines and articles mostly |
| I try to avoid reading whenever possible |
| Do you consider yourself artistic?
(Writing, music, drawing/painting, etc) | Yes |
| No |
| What is your current relationship
status? | Single and dating |
| Long Term Relationship |
| Single and not interested in dating |
| Married |
| Divorced |
| Separated |
| Sexual Orientation | Heterosexual |
| Homosexual |
| Bisexual |
| I don't have sex |
| Do you have children? | Yes |
| No, but hoping to some day |
| No,
I do not wish to have children |
| What other questions do you think could
be meaningful in this questionnaire? | |
| |
