. You may have more than per question 1. My gender schema: _____ _____ _____ _____ _____ Very masculine Masculine Androgynous (equal balance) Feminine Very feminine 8. My childhood included: _____ _____ _____ _____ _____ Physical abuse Psychological abuse Sexual abuse All of the above Does not apply
2. My general intellect (IQ): _____ _____ _____ _____ _____ Above average Slightly above average Slightly below average Below average Does not apply
9. My mental state: _____ _____ _____ _____ _____ Stable Rarely unstable Often unstable Unstable Does not apply
3. My education plan: _____ _____ _____ _____ _____ High school only Technical school College Graduate school Does not apply
10. My attitude in relation to suicide: _____ _____ _____ _____ _____ Inconceivable Conceivable Attempted Multiple attempts Does not apply
4. My parents marital status: _____ _____ _____ _____ _____ Happily Married Married Re-married Separated/Divorced Does not apply
11. My attitude toward legal pornography: _____ _____ _____ _____ _____ Disgust Tolerance Amusement Enjoyment Does not apply
5. I was raised primarily by: _____ _____ _____ _____ _____ Mother only Father only Mother and father Relatives Does not apply
12. My potty-training: _____ _____ _____ _____ _____ Earlier than most Typical Slightly delayed Delayed Does not apply
6. My family history includes: _____ _____ _____ _____ _____ Deviance (criminal behavior) Psychiatric (mental) difficulty Alcoholism/drug abuse All of the above Does not apply
13. My attitude toward fire: _____ _____ _____ _____ _____ Fear Tolerance Amusement Fascination Does not apply
7. Feelings for my primary caregiver: _____ _____ _____ _____ _____ Love Like Dislike Hate Does not apply
14. My attitude toward animals: _____ _____ _____ _____ _____ Love Like Dislike Hate Does not apply