Interpersonal Relationships

You have been selected to participate in a study attempting to investigate possible correlations between self-esteem level and interpersonal well-being. You will be asked to rate a series of statements from strongly agree to strongly disagree. These results will be used in our study to analyze self-esteem level. You are required to put your name, however names and results will be confidential to all except the researchers. There is a chance that you may be contacted after your completion of this survey to participate in a case study. Once taking this survey, you have the right to withdraw at any time, however if taking this survey, we ask that you answer all questions honestly. This is a short survey and will help us greatly in our research if you choose to go through with it.
Thank you for your participation.


A red asterisk (*) indicates required questions.

  1. Do you consent to participating in this survey?*
    Yes
    No


  1. As a whole, I am satisfied with myself.*
      1 2 3 4 5  
    Strongly agree   Strongly disagree


  1. I feel that I have a number of good qualities.*
      1 2 3 4 5  
    Strongly agree   Strongly disagree


  1. I am able to do things better than most other people.*
      1 2 3 4 5  
    Strongly agree   Strongly disagree


  1. All in all, I am inclined to feel that I am a success. *
      1 2 3 4 5  
    Strongly agree   Strongly disagree


  1. I have a close friend that I tell everything to. *
    Yes
    No


  1. My friends think very highly of me.*
    Yes
    No


  1. I feel that I get along well with others. *
      1 2 3 4 5  
    Strongly agree   Strongly disagree


  1. I feel that I am unique.*
      1 2 3 4 5  
    Strongly agree   Strongly disagree


  1. I feel that people really like to talk with me.*
      1 2 3 4 5  
    Strongly agree   Strongly disagree


  1. I feel that I make a good impression on others. *
      1 2 3 4 5  
    Strongly agree   Strongly disagree


  1. I feel that I have a lot of self-confidence.*
      1 2 3 4 5  
    Strongly agree   Strongly disagree


  1. I think my friends find me interesting. *
      1 2 3 4 5  
    Strongly agree   Strongly disagree


  1. I feel that if more people were like me, they would be happier.*
      1 2 3 4 5  
    Strongly agree   Strongly disagree


  1. How many days this week did you spend with peers outside of school?*
    None
    Less than 1
    2-3
    4-5
    6-7


  1. How many days this week did you spend alone outside of school? *
    None
    Less than 1
    2-3
    4-5
    6-7


  1. I attend school with a friend that I can tell all of my problems to*
    Yes
    No


  1. When my friends succeed, I feel better about myself. *
    Yes
    No


  1. Is there someone whom you can really count on to listen to you when you need to talk?*
    Yes
    No


  1. Do you have someone with whom you can totally be yourself?*
    Yes
    No


  1. Do you have someone whom you can count on to help you in a crisis situation even if they would have to go out of their way to help you?*
    Yes
    No


  1. Do you feel you have someone who appreciates you as a person?*
    Yes
    No


  1. Do you have someone whom you can count on to console you when you are very upset?*
    Yes
    No


  1. Are you currently in a relationship?*
    Yes
    No


  1. How old are you?





Amanda Baskett