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Please print, and complete all information.
Name: _____________________________________
Address: ___________________________________
City, State, Zip: _____________________________
SSN (or equiv.): ______________ (nine digits required)
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Instructions: This is a survey. There are no right or wrong answers.
Circle the numbers below which best describe How You Feel You Really Are.
(When not under outside pressure) Mark your responses quickly; your first impression is usually best.
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Guide: 1 - Rarely 2 - Seldom 3 - Sometimes 4 - Often 5 - Usually
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1. Individualistic
2. Spirited
3. Shy
4. Stick-to-it
5. Understanding
6. Precise
7. Spontaneous
8. Logical
9. Cautious
10. Talkative
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1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
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11. Daring
12. Demanding
13. Peruasive
14. Outgoing
15. Earnest
16. Pleasant
17. Stable
18. Kind-hearted
19. Enthusiastic
20. Impulsive
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1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
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21. Aggressive
22. Industrious
23. Compassionate
24. Careful
25. Controlling
26. Thoughtful
27. Charming
28. Calm
29. Fussy
30. Agreeable
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1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
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Note New Instructions:
Circle the numbers below which best describe How Others Expect You To Act.
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Guide: 1 - Rarely 2 - Seldom 3 - Sometimes 4 - Often 5 - Usually
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1. Competitive
2. Sophisticated
3. Tolerant
4. Dynamic
5. Serious
6. Responsive
7. Dominant
8. Self-assured
9. Loyal
10. Outstanding
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1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
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11. Persistent
12. Bold
13. Esteemed
14. Eager
15. Congenial
16. Patient
17. Steady
18. Relaxed
19. Convincing
20. Popular
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1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
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21. Forceful
22. Confident
23. Sympathetic
24. Accurate
25. Conventional
26. Charitable
27. Appealing
28. Neighborly
29. Assertive
30. Gentle
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1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
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Be sure all 60 items are marked.
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Richard A. Knopf & Associates, Inc. 1424 Old Orchard Drive, Irving, Texas 75061
Drake P3™ © Copyright 1988, 1990, 1993
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