SELF-DESCRIPTION FORM

In better understanding how you see yourself, it would be helpful if you would answer the following.

What three adjectives best describe you?
1.
2.
3.


What are your three best personality traits?
1.
2.
3.


What are your three worst personality traits?
1.
2.
3.


Almost Always Usually Sometimes Not Often Rarely
1. I am happy 1. 2. 3. 4. 5.
2. I feel good about myself 1. 2. 3. 4. 5.
3. I am independent 1. 2. 3. 4. 5.
4. I get along well with others 1. 2. 3. 4. 5.
5. I do well at my job (or school) 1. 2. 3. 4. 5.
6. I am sensitive 1. 2. 3. 4. 5.
7. I am angry 1. 2. 3. 4. 5.
8. I am sad 1. 2. 3. 4. 5.
9. I am nervous 1. 2. 3. 4. 5.
10. I am afraid 1. 2. 3. 4. 5.
11. I get into confrontations with others 1. 2. 3. 4. 5.
12. I suffer from head aches, stomach aches, or other somatic complaints 1. 2. 3. 4. 5.
13. I do not play by the rules 1. 2. 3. 4. 5.

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