SELF EVALUATION QUESTIONNAIRE

Name of the Student: Class: Address: Occupation, if any:

Age:

Sex: M/F

Date of Testing:

Instructions: This questionnaire consists of 15 statements. There are 5 ratings in this questionnaire.
They are Strongly Disagree, Disagree, Neutral, Agree and Strongly Agree. Read each item carefully and put  mark on one answer that corresponds to your agreement or disagreement. There is no right or wrong answers. Answer all the statements.

Sl No. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

STATEMENT D Committed to communication Be honest with yourself Taking responsibilities for our own actions and reactions Sharing feelings with others Courageous to share your weakness Expressing gratitude to our listener Be empathic and reassuring by trying to put yourself in the other persons shoes. Offer suggestions and never directions. Avoid all blocks to communication Thank others, who have shared their thoughts and feelings with us Spend quality time with each other Stretch beyond routines Apologise when appropriate and helpful Avoid build up of tension Communication can be non-verbal. Touch can express much more than words can say

RATING SD N

SA

SELF EVALUATION QUESTIONNAIRE

ANSWER SHEET Name of the Student: Class: Address: Instructions:This questionnaire consists of 15 statements. There are 5 ratings in this questionnaire.
They are Strongly Disagree, Disagree, Neutral, Agree and Strongly Agree. Read each item carefully and put  mark on one answer that corresponds to your agreement or disagreement. There is no right or wrong answers. Answer all the statements.

Age: Occupation, if any:

Sex: M/F

Sl No.. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

RATING SD N

SA