Self Esteem Survey Conclusion
Parent's Email Address
*
example@example.com
Child's Gender
*
Please Select
Male
Female
N/A
Age
*
5
9
6
10
7
11
8
12
Current Location
*
Central America
North America
South America
Caribbean Islands
Pacific Islands
Europe
Africa
Asia
Australia
Other
How many days did you say the affirmations?
*
None
1-2 days
3-5 days
6-8 days
9-13 days
14 days
Did you mostly read the affirmations or did you mostly use the song/video?
*
I mostly read the affirmations
I mostly used the video
I did both equally
I did not say the affirmations at all
How did saying the affirmations make you feel? (This question is optional)
Survey for the Child Participant
Below is a list of statements dealing with your general feelings about yourself. Please indicate how strongly you agree or disagree with each statement.
Please answer these questions as honestly as possible. You will not be judged on your responses.
*
Rows
Strongly Agree
Agree
Disagree
Strongly Disagree
Overall, I am satisfied with myself.
At times I think I am no good at all.
I feel that I have a good number of qualities.
I am able to do things as well as most people.
I feel that I do not have much to be proud of.
I feel useless at times.
I feel I am a person of worth. I am equal to others.
I wish I could have more respect for myself.
Overall, I am inclined to feel like I am a failure.
I take a positive attitude towards myself.
For the participant: Do you have any feedback or comments about this process? (This question is optional)
For the parent: Do you have any feedback or comments about this process? (This question is optional)
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