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Gender
 
 
Age
 
 
Race / ethnicity
 
 
Religion
 
 
Place of birth
 
Rate how much the following factors influence you on gender roles and its related issues
Not influence Slightly influence Moderately influence Strongly influence Greatly influence N/A
Father
Mother
Brother(s)
Sisters(s)
Friend(s) of same sex
Friend(s) of different sex
Teacher(s)
Printed teaching materials (eg. text books)
School activities (eg. clubs, societies)
Books (eg. novels, storybooks)
Magazines
Movies / Dramas
Advertisements / Commercials
 
Rate how much you agree on each of the following statements is in describing you
Strongly Disagree Disagree Neutral Agree Strongly Agree
I don’t like to waste my time daydreaming.
Once I find the right way to do something, I stick to it.
I am intrigued by the patterns I find in art and nature.
I believe letting students hear controversial speakers can only confuse/mislead.
Poetry has little or no effect on me.
I often try new and foreign foods.
I seldom notice the moods or feelings that different environments produce.
I believe we should look to our religious authorities for decisions on moral issues.
Sometimes with poetry of a work of art, I feel a chill or wave of excitement.
I have little interest in speculating on the universe or the human condition.
I have a lot on intellectual curiosity.
I often enjoy playing with abstract theories or abstract ideas.
 
 
1. I’d prefer to deal with people who are
 
Conventional and polite in what they say
 
Direct and speak up about problems they see
 
Neither
 
 
 
2. I like to think up better ways of doing thing rather than to follow well-tried ways
 
True
 
False
 
Neither
 
 
 
3. If I had to cook or build something, I’d follow the directions exactly
 
True, why take chances
 
False, I’d probably try to make it more interesting
 
Neither
 
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