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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. ok
*** You may choose more than one in each category ***
2. but answer as simply as possible. alright
3. If you would like to write an explanation for your answers, you may. eh
4. All responses will be kept confidential. cool
*** Self-Image: ***
5. I am a Hottie 5 - I don't feel like I am.
6. I am Eye Candy 4
7. I am Beautiful 2
8. I am Good Looking 1
9. I am Okay 3
10. I am Not Attractive 6 - I feel unattractive when I compare myself to other girls.
11. I am Fat 7 - I feel anorexic when I look in the mirror but when I look at myself w/o a mirror I feel fat.
12. I am a MILF 8 - ew
13. Other:___________ n/a
*** I Dress the Way I Do, Because: ***
14. I feel like it 2
15. I want to 3
16. I need to 7
17. I feel powerful when I do 6
18. I love what I wear 4
19. I like the response I get, even if it's not the response I want 5
20. Other:___________ 1 - I want to express my true emotions through my appearance.
*** I Like It When: ***
21. Men look at my Pictures on MySpace 6
22. Men get "excited" over my pictures on MySpace 5
23. Men relate to me as a desirable female 3 - Definitely.
24. Men leave me messages about how "Hot" I am 4 - It makes me feel more confident about my looks.
25. Men pay any attention at all to me 1 - I love it.
26. Men leave me alone 7
27. Other:___________ 2 - Men tell me I am beautiful.
*** It Bothers Me When: ***
28. I am posing in a way to illicit a response from men in pictures 4 - I would like to get a positive response without having to act a certain way to impress men.
29. I men judge me as an object 3
30. I am treated as less than special 2
31. People don't seem to see the "real me" 1
32. Other:___________ n/a
*** I am Happiest When: ***
33. I am appreciated 3
34. I am treated with respect 7
35. I am acknowledged 4
36. I am loved 1
37. I am sexy 2
38. I am shopping 6
39. I am successful 5
40. Other:___________ n/a
*** What I Need Most in Life to Feel Fulfilled is: ***
41. Love 1
42. Respect 6
43. Happiness 2
44. Sex 4
45. Money 7
46. Clothes 5
47. A Hug 3
48. Other:___________ n/a
*** The Biggest "Pain" I Deal With is Because I was/Have Been ***
49. Lied to 4
50. Hurt 3
51. Abandoned 2
52. Injured 5
53. Raped n/a
54. Victimized as a Child n/a
55. Heartbroken 1
56. Other:___________ n/a
*** I deal with the Following: ***
57. Addiction to medications/drugs (prescription or otherwise) n/a
58. Alcohol n/a
59. Over-eating 3 - I don't eat for a period of time but then I over-indulge later.
60. Temper/Anger 2
61. Depression 1 - This has change my life completely.
62. Other:___________ n/a
*** My Biggest Fear Is: ***
63. I won’t be a success 6
64. I won’t be taken seriously 16
65. I’ll go unnoticed 13
66. I won't be a good wife 4
67. I won't be a good mother 5
68. I will never find a partner in life 8
69. I made a mistake getting together with the one I'm with (married or not) 14
70. I will never get married 9
71. I will never find a partner who is "worthy of me" 15
72. I am not worthy of being loved by someone 1
73. My children will not be well adjusted 11
74. I am going to hurt my children 10
75. I am going to hurt myself (or hurt myself again) 2
76. I am a powerful person n/a
77. I will be successful 18
78. I will not know how to handle success when it comes 7
79. I am afraid of people 17
80. I am afraid of going outside n/a
81. I am afraid of speaking in public 12
82. I am afraid of being raped (or raped again) 19
83. Other:___________ (see this list for some examples: http://www.phobialist.com/reverse.html) 3 - showering in a bath with a curtain
*** I Prefer the Company of: ***
84. Men 5
85. Women 6
86. Teens 1 - I feel more relaxed around people my age.
87. Children 4
88. Girls 3 - I feel a competition with other girls.
89. Boys 2 - I feel more comfortable with the opposite sex.
90. Elderly 7 - I don't really like old people.
91. Other:___________ n/a
*** I My Perfect World I Would Be: ***
92. A Model 7
93. A Singer/Musician 4
94. An Actor 8
95. A Director 9
96. A Manager 10
97. A Mother 6
98. A Bride 5
99. Loved by Anyone 2
100. Loved by Someone 1
101. Find love that was real and lasting 3
102. Other:___________ n/a