San Antonio Faith-Based Initiative Questionnaire

Directions: The following statements ask about your thoughts, feelings, beliefs and behaviors in various situations. Using the scale provided, please choose the number that best describes you for each item. A 1 indicates it is NOT AT ALL true of you and 5 indicates that it is VERY true of you. Numbers 2-4 indicate how well it describes you in between these points. Think deeply about your answers and choose the number that comes closest to how you know yourself the best.
Disclaimer: This survey is completely anonymous. No personally-identifying information will be recorded. Only answer questions you feel comfortable answering. You may discontinue the survey at any time. Thank you for your participation.

* 1. What is your zip code of residence?

* 2. What is your gender?

* 3. What is your race/ethnicity?

* 4. What is your age?

* 5. In which of the following industries are you employed or intend to join?

* 6. When I see people I do not know being sad, I feel a need to reach out to them.

* 7. I’m disapproving and judgmental about my own flaws and inadequacies.

* 8. I accept others I do not know even when they do things I think are wrong.

* 9. When something upsets me I try to keep my emotions in balance.

* 10. I respect others, no matter who they are.

* 11. When I’m going through a very hard time, I give myself the caring and tenderness I need.

* 12. When people cry in front of me, I often don’t feel anything at all.

* 13. One of the activities that provides me with the most meaning to my life is helping others who need help.

* 14. I believe that even strangers deserve my full respect.

* 15. I tend to feel compassion for people, even though I do not know them.

* 16. I give freely to others without expecting anything back.

* 17. When I feel inadequate in some way, I try to remind myself that feelings of inadequacy are shared by most people.

* 18. I pay careful attention when other people talk to me.

* 19. I don’t concern myself with other people’s problems.

* 20. I try to avoid people who are experiencing a lot of pain.

* 21. I try to put myself in a stranger’s shoes when he or she is in trouble.

* 22. When I fail at something important to me, I become consumed by feelings of inadequacy.

* 23. I will sacrifice my own needs to meet the needs of others.

* 24. When I’m feeling down I tend to obsess and fixate on everything that’s wrong.

* 25. I show kindness toward others whom I don’t know.

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