You are on page 1of 14

Demographics

Subject ID Gender

________________ _____F ____M Sophomore Junior Senior

Year in School(circle one): Freshman Age ________

Race/Ethnicity:___________________________ (Use Code) 1. White (Not of Hispanic Origin) 3. Black British 5. American Indian/Native American 7. Hispanic Mexican 9. Hispanic Cuban 11. Brazilian 13. Asian (Far East) 15. Pacific Islander 2. Black (Not of Hispanic Origin) 4. Afro-Caribbean 6. Alaskan Native 8. Hispanic Puerto Rican 10. Other Hispanic 12. Asian (Indian subcontinent) 14. Middle Eastern 16. Other (Please specify)________________

Religion:______________________________ (Use Code) 1. Catholic 2. Buddhist 3. Protestant 4. Hindu 5. Jewish 6. Atheist 7. Islam 8. Agnostic

9. Other __________

How often do you attend religious services? _____________________ (Use Code) 1. Never 2. Once a year or less 3. Several times per year 4. Several times per month 5. Once a week 6. More than once a week In your development, how much did your parents stress the importance of religion? ____ 1. Not at all 2. A little 3. Somewhat 4. A fair amount 5. A good deal 6. Very much 7. Extremely

LOT-R Please be as honest and accurate as you can throughout. Try not to let your response to one statement influence your responses to other statements. There are no "correct" or "incorrect" answers. Answer according to your own feelings, rather than how you think "most people" would answer. A = I agree a lot B = I agree a little C = I neither agree nor disagree D = I DISagree a little E = I DISagree a lot 1. In uncertain times, I usually expect the best. 2. It's easy for me to relax. 3. If something can go wrong for me, it will. 4. I'm always optimistic about my future. 5. I enjoy my friends a lot. 6. It's important for me to keep busy. 7. I hardly ever expect things to go my way. 8. I don't get upset too easily. 9. I rarely count on good things happening to me. 10. Overall, I expect more good things to happen to me than bad. _____ _____ _____ _____ _____ _____ _____ _____ _____ _____

Tripartite Anguish Intensity Scale

Below are nine questions regarding your own personal experience that you should answer with a yes or no response. Following a yes response, you will be asked to use a 1-10 scale to indicate how much the experience has affected you.

1. Are you experiencing or have you recently experienced any chronic pain (i.e. back pains)? ____ Yes ____ No 1 2 3 4 5 6 7 8 Not At Moderatel All y If so, how intense?

10 Extremely

2. Have you recently experienced or are you experiencing rejection by another individual for which you had or have feelings for? ____Yes ____ No 1 2 3 4 5 6 7 8 9 10 Not At Moderatel Extremely All y If so, how intense?

3. Are you experiencing or have you recently experienced an argument with a close friend or relative (i.e. regarding a monetary dispute, philosophical differences, etc.)? ____ Yes ____ No 1 2 3 4 5 6 7 8 9 10 Not At Moderatel Extremely All y If so, how intense?

4. Have you recently or are you currently dealing with the loss of a former or current a significant other? ____ Yes

____ No 1 Not At All If so, how intense? 2 3 4 5 Moderatel y 6 7 8 9 10 Extremely

5. Are you experiencing or have you recently experienced betrayal by a close or trusted friend (i.e. divulged secret)? ____ Yes ____ No 1 2 3 4 5 6 7 8 9 10 Not At Moderatel Extremely All y If so, how intense?

6. Are you experiencing or have you recently experienced a sudden life-altering injury (i.e. paralysis, amputation, etc.)? ____Yes ____No 1 2 3 4 5 6 7 8 9 10 Not At Moderatel Extremely All y If so, how intense?

7. Are you experiencing or have you recently experienced the sudden loss of a friend (i.e. death, separation, etc.)? ____ Yes ____ No 1 2 3 4 5 6 7 8 9 10 Not At Moderatel Extremely All y If so, how intense?

8. Have you recently experienced or are you experiencing infidelity (cheating) from a partner with whom you have been or currently are in a long-term relationship/marriage with? ____Yes ____No 1 2 3 4 5 6 7 8 9 10

Not At All If so, how intense?

Moderatel y

Extremely

9. Are you experiencing or have you recently experienced a life threatening illness (i.e. cancer, STD, etc.)? ____Yes ____No 1 2 3 4 5 6 7 8 9 10 Not At Moderatel Extremely All y If so, how intense?

Daily Spiritual Experience Scale The list that follows includes items you may or may not experience. Please consider if and how often you have these experiences, and try to disregard whether you feel you should or should not have them. In addition, a number of items use the word God. If this word is not a comfortable one, please substitute another idea that calls to mind the divine of holy for you. 1. I feel Gods presence. 1. Many times a day 2. Every day 3. Most days 4. Some days 5. Once in a while 6. Never or almost never 2. I experience a connection to all life. 1. Many times a day 2. Every day 3. Most days 4. Some days 5. Once in a while 6. Never or almost never 3. During worship, or at other times when connecting with God, I feel joy which lifts me out of my daily concerns. 1. Many times a day 2. Every day 3. Most days 4. Some days 5. Once in a while 6. Never or almost never

4. I find strength in my religion or spirituality. 1. Many times a day 2. Every day 3. Most days 4. Some days 5. Once in a while 6. Never or almost never 5. I find comfort in my religion or spirituality. 1. Many times a day 2. Every day 3. Most days 4. Some days 5. Once in a while 6. Never or almost never 6. I find deep inner peace or harmony. 1. Many times a day 2. Every day 3. Most days 4. Some days 5. Once in a while 6. Never or almost never

7. I ask for Gods help in the midst of daily activities. 1. Many times a day 2. Every day 3. Most days 4. Some days 5. Once in a while

6. Never or almost never 8. I feel guided by God in the midst of daily activities. 1. Many times a day 2. Every day 3. Most days 4. Some days 5. Once in a while 6. Never or almost never 9. I feel Gods love for me, directly. 1. Many times a day 2. Every day 3. Most days 4. Some days 5. Once in a while 6. Never or almost never 10. I feel Gods love for me, through others. 1. Many times a day 2. Every day 3. Most days 4. Some days 5. Once in a while 6. Never or almost never 11. I am spiritually touched by the beauty of creation. 1. Many times a day 2. Every day 3. Most days

4. Some days 5. Once in a while 6. Never or almost never 12. I feel thankful for my blessings. 1. Many times a day 2. Every day 3. Most days 4. Some days 5. Once in a while 6. Never or almost never 13. I feel a selfless caring for others. 1. Many times a day 2. Every day 3. Most days 4. Some days 5. Once in a while 6. Never or almost never 14. I accept others even when they do things I think are wrong. 1. Many times a day 2. Every day 3. Most days 4. Some days 5. Once in a while 6. Never or almost never 15. I desire to be closer to God or in union with God. 1. Many times a day

2. Every day 3. Most days 4. Some days 5. Once in a while 6. Never or almost never

16. In general, how close do you feel to God? 1. Many times a day 2. Every day 3. Most days 4. Some days 5. Once in a while 6. Never or almost never

The Flourishing Scale Below are 8 statements with which you may agree or disagree. Using the 17 scale below, indicate your agreement with each item by indicating that response for each statement. 7 6 5 4 3 2 1 Strongly agree Agree Slightly agree Mixed or neither agree nor disagree Slightly disagree Disagree Strongly disagree _____ _____ _____ _____

1. I lead a purposeful and meaningful life. 2. My social relationships are supportive and rewarding. 3. I am engaged and interested in my daily activities. 4. I actively contribute to the happiness and well-being of others. 5. I am competent and capable in the activities that are important to me. _____ 6. I am a good person and live a good life. 7. I am optimistic about my future. 8. People respect me.

_____ _____ _____

Satisfaction with Life Scale Below are five statements that you may agree or disagree with. Using the 1 - 7 scale below, indicate your agreement with each item by placing the appropriate number on the line preceding that item. Please be open and honest in your responding.

7 - Strongly agree 6 - Agree 5 - Slightly agree 4 - Neither agree nor disagree 3 - Slightly disagree 2 - Disagree 1 - Strongly disagree

____ In most ways my life is close to my ideal. ____ The conditions of my life are excellent. ____ I am satisfied with my life. ____ So far I have gotten the important things I want in life. ____ If I could live my life over, I would change almost nothing.

You might also like