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"Survey for Women" was made by chaplains.

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*** These question are serious and will help in writing several articles and a book I am preparing. ***
1. Please rate the following statements by how you would apply them to yourself, and as honestly as possible. No Answer
*** You may choose more than one in each category ***
2. but answer as simply as possible. No Answer
3. If you would like to write an explanation for your answers, you may. No Answer
4. All responses will be kept confidential. No Answer
*** Self-Image: ***
5. I am a Hottie um....no.
6. I am Eye Candy once again, no.
7. I am Beautiful nope.
8. I am Good Looking NO.
9. I am Okay once in a while
10. I am Not Attractive that pretty much says it all.
11. I am Fat yeah. oh yeah.
12. I am a MILF i can't remember what that means, but recall hearing it in American Pie.
13. Other:___________ No Answer
*** I Dress the Way I Do, Because: ***
14. I feel like it yup.
15. I want to yup. and I can't afford nicer clothes.
16. I need to ok then.
17. I feel powerful when I do ...???
18. I love what I wear sometimes.
19. I like the response I get, even if it's not the response I want depends on who the response is from and what it pertains to.
20. Other:___________ No Answer
*** I Like It When: ***
21. Men look at my Pictures on MySpace only our friends can view our pics
22. Men get "excited" over my pictures on MySpace seriously doubt it, unless they think my 13yr old daughter is "cute".
23. Men relate to me as a desirable female no.
24. Men leave me messages about how "Hot" I am nope.
25. Men pay any attention at all to me my husband does.
26. Men leave me alone for the most part.
27. Other:___________ No Answer
*** It Bothers Me When: ***
28. I am posing in a way to illicit a response from men in pictures no.
29. I men judge me as an object nope.
30. I am treated as less than special IDK.
31. People don't seem to see the "real me" IDK what other ppl think or see.
32. Other:___________ No Answer
*** I am Happiest When: ***
33. I am appreciated I am almost never happy.
34. I am treated with respect By my husband and daughter. Not by my son though.
35. I am acknowledged Most of the time. At least by my therapist.
36. I am loved I hope so.
37. I am sexy HAHAHA.
38. I am shopping Is that worded right?
39. I am successful Not really. Or rather, not at all.
40. Other:___________ No Answer
*** What I Need Most in Life to Feel Fulfilled is: ***
41. Love Is this a mark an "x" when you agree sort of thing? Ok then, x.
42. Respect x
43. Happiness No Answer
44. Sex No Answer
45. Money No Answer
46. Clothes No Answer
47. A Hug x
48. Other:___________ No Answer
*** The Biggest "Pain" I Deal With is Because I was/Have Been ***
49. Lied to x
50. Hurt x
51. Abandoned No Answer
52. Injured x
53. Raped x
54. Victimized as a Child x
55. Heartbroken x
56. Other:___________ finding out my exhusband molested my daughter for pretty much the whole 4yrs we were married.
*** I deal with the Following: ***
57. Addiction to medications/drugs (prescription or otherwise) No Answer
58. Alcohol No Answer
59. Over-eating x
60. Temper/Anger at times.
61. Depression x
62. Other:___________ Schizoaffective Disorder, Anxiety, PTSD.
*** My Biggest Fear Is: ***
63. I won’t be a success No Answer
64. I won’t be taken seriously x
65. I’ll go unnoticed No Answer
66. I won't be a good wife x
67. I won't be a good mother x
68. I will never find a partner in life No Answer
69. I made a mistake getting together with the one I'm with (married or not) No Answer
70. I will never get married No Answer
71. I will never find a partner who is "worthy of me" No Answer
72. I am not worthy of being loved by someone x
73. My children will not be well adjusted x
74. I am going to hurt my children No Answer
75. I am going to hurt myself (or hurt myself again) x
76. I am a powerful person No Answer
77. I will be successful No Answer
78. I will not know how to handle success when it comes x
79. I am afraid of people x
80. I am afraid of going outside No Answer
81. I am afraid of speaking in public No Answer
82. I am afraid of being raped (or raped again) x
83. Other:___________ (see this list for some examples: http://www.phobialist.com/reverse.html) No Answer
*** I Prefer the Company of: ***
84. Men My husband.
85. Women x
86. Teens My daughter.
87. Children My son.
88. Girls No Answer
89. Boys No Answer
90. Elderly My parents.
91. Other:___________ No Answer
*** I My Perfect World I Would Be: ***
92. A Model No Answer
93. A Singer/Musician No Answer
94. An Actor No Answer
95. A Director No Answer
96. A Manager No Answer
97. A Mother No Answer
98. A Bride No Answer
99. Loved by Anyone No Answer
100. Loved by Someone x
101. Find love that was real and lasting No Answer
102. Other:___________ No Answer