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1. Hello Valued Life Insights' Client:
ACCEPTANCE OF THE FOLLOWING STATEMENTS REPRESENT A LEGAL COMMITMENT BY YOU SO PLEASE READ THE FOLLOWING VERY CAREFULLY!
Welcome to the Life Insights Adult Evaluation by Others Questionnaire for you to evaluate persons other than yourself. The purpose of this questionnaire is to create a baseline of your perceptions of another designated person (the "Designee") as a basis for identifying their self-imposed limitations, misperceptions and opportunities for optimizing their future. A Life Insights mentor will review your data input and schedule a time to discuss the results with you to clarify a mutual understanding and chart a path forward with the Designee.
This data will be a reference point in Phase 3 of the Life Insights process where the Designee will review the Life Insights summary of axioms and insights. Phase 3 is designed to introduce the Designee to a higher awareness that will hopefully advance the Designee's life progression to achieve the Designee's goals and ambitions by providing the Designee with a competitive advantage versus their peers.
The survey is somewhat lengthy in an an effort to create a comprehensive evaluation, but please take your time and carefully consider the answers to each question before answering. The end results of the Life Insights process are directly correlated to the accuracy and complete candor of your and the Designee's responses to this questionnaire and the Designee's self-evaluation questionnaire. Your responses will be compared to the Designee's responses to identify any significant variations in the Designee's self-perceptions and yours. The answers are completely confidential WITH THE DESIGNEE INCLUDED so this is an opportunity to take a serious look at the Designee in a systematic way because you genuinely care about the Designee and want to help the Designee reach their full life potential. This questionnaire is not a test, and your participation in this process is completely voluntary and for your personal benefit and the benefit of the Designee. There are no foreseeable risks associated with this process other than the Designee's reactions to your candid responses. You certify that you have considered these potential consequences with the Designee in advance and you have both concluded that the potential benefits of the Life Insights process outweigh the risks of mutual candor about important issues.
However, if you feel uncomfortable answering any questions, you may ignore individual questions or you can withdraw from the questionnaire at any point without any disclosure to the Designee. If you want to cancel your participation after starting the questionnaire, please advise Life Insights at [email protected] as soon as you withdraw.
Your questionnaire responses will be strictly confidential and data from this process will be reported only to you and the Designee unless you and the Designee authorize others to see your responses in writing. If you have questions at any time about the questionnaire or the procedures, you may contact [email protected]
By checking the box below you certify that you are an adult over the age of 18 of sound mind and have never been diagnosed with any psychiatric disorder. You acknowledge that you are not under the care of a psychological or psychiatric care professional. You accept that Life Insights, LLC or its owners or employees incur no liability to you of any kind by allowing you to complete this questionnaire. You understand that Life Insights mentors are not licensed counselors or psychiatric professionals. You acknowledge that you and you alone are responsible for your actions, your responses or the consequences that might result from this process. If you choose to release data from this questionnaire to Designee or others, you accept full responsibility for the consequences and will hold Life Insights harmless. You acknowledge that you have discussed the implications of the Life Insights' process with the Designee and have disclosed anyone who you have authorized to see your data to the Designee AND DESIGNEE HAS CONCURRED WITH THE RELEASE. You certify that your intentions in this process are positive in trying to help the Designee.
DO NOT PROCEED WITH THIS QUESTIONNAIRE IF YOU ARE NOT IN COMPLETE AGREEMENT WITH THE STATEMENTS ABOVE OR ARE NOT EMOTIONALLY CAPABLE OF DEALING WITH ANY REACTIONS OR RESPONSES THAT MAY ARISE FROM OTHERS YOU DESIGNATE TO SEE YOUR RESPONSES!! THEIR REACTIONS ARE YOUR RESPONSIBILITY ONLY!!
Important Notice: The questionnaire format and its content are copyrighted, highly confidential and the proprietary property of Life Insights, LLC. They are not to be copied by anyone for any purpose.
Thank you very much for your time and interest in helping the Designee with their self-evaluation. Please start by selecting the "I Agree" button below and then clicking on the Continue button below.
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2. Your Contact Information
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3. Please confirm your relationship to the person you are evaluating in this questionnaire (the "Designee")? |
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| 4. Please enter the full name of the person you are evaluating (the "Designee"). | | |
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5. Where was Designee in the birth order of their original family? |
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6. How would you rate Designee's birth family/socioeconomic circumstances versus other people in their society? |
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7. How would you rate the Designee's childhood? Please comment briefly |
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8. How would you rate the Designee's childhood upbringing versus other people in their society? |
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9. Please rate the quality of the Designee's educational opportunities as a child. |
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10. Overall, rate the Designee's father as a parent. |
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11. Please describe the Designee's current relationship with their father. |
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12. Overall, rate the Designee's mother as a parent. |
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13. Please describe the Designee's current relationship with their mother. |
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14. How would you rate the affection the Designee received from their parents as a child? |
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15. Was the Designee physically abused a child? |
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16. Was the Designee verbally or emotionally abused or neglected as a child? |
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17. How would you rate the Designee's intellect versus people in general in your society? |
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18. How would you rate the Designee's overall personal appearance versus others in their age group? |
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19. Overall and historically, how would you rate the Designee as an athlete? |
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20. From an overall behavioral perspective, rate the Designee as a child versus their peer group. |
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21. How would you rate the Designee as a student? (past or present tense) |
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22. Please confirm the Designee's education level |
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23. Please rate the Designee's career achievement versus their age peers. |
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24. Please rate the Designee's overall career job income performance versus their age peers. |
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25. Please rate the Designee's current income performance versus their age peers. |
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26. How would you rate the Designee's current family/socio-economic circumstances versus other people in their society? |
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27. How would the Designee rate their boss? |
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28. How would you rate the Designee's career versus their aspirations at this point? |
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29. How would you rate the Designee as a financial provider now? |
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30. How would you rate the Designee's future career prospects? |
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31. How would you rate the Designee's current lifestyle versus their current age? |
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32. How do you rate the Designee's as an achiever versus their age peer group and their potential? |
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33. How would you rate the Designee as a boss? |
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34. How would you rate the Designee as an employee? |
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35. Is the future more of a problem or an opportunity for the Designee? |
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36. Generally, how happy is the Designee? |
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37. Overall, how does the Designee feel about their future? |
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38. How much of the Designee's life potential have they achieved given their current age? |
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39. Overall, how would you rate the Designee's life experience to date? |
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40. How would you rate the Designee's general outlook? |
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41. How does the Designee feel about America's future? |
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42. How competitive is the Designee? |
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43. How would you rate the Designee's breadth of knowledge versus their age group? |
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44. How would you rate the Designee's sense of style versus other people in their peer group? |
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45. How tactful is the Designee? |
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46. How persuasive is the Designee? |
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47. Generally, how would you rate the Designee's charisma? |
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48. How reliable is the Designee's intuition? |
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49. How would you rate the Designee's sense of humor versus other people in general? |
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50. How would you rate the Designee as a conversationalist? |
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51. How would you rate the Designee's overall social skills versus other people? |
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52. How well is the Designee generally liked by other people? |
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53. How would you rate the Designee's self confidence versus your age peer group? |
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54. How would you rate the Designee as a hard worker? |
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55. How would you rate the Designee as a learner? |
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56. How would you rate the Designee's imagination? |
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57. How would you rate the Designee as a listener? |
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58. How would you rate the Designee as a writer? |
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59. How would you rate the Designee as a reader? |
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60. How would you rate the Designee's overall personality versus other people? |
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61. How would you rate the Designee as a leader? |
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62. How would you rate the Designee's level of curiosity/inquisitiveness? |
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63. How do you rate the Designee as a follower versus a leader? |
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64. Is the Designee generally reactive or proactive? |
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65. Overall, how do you rate the Designee's analytical/reasoning ability? |
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66. How do you rate the Designee's artistic ability? |
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67. How do you rate the Designee's musical abilities? |
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68. How do you rate the Designee's mathematics ability? |
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69. How do you rate the Designee's mechanical/engineering/scientific understanding ability? |
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70. How would you rate the Designee's business analytical abilities? |
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71. How would you rate the Designee's ability to change, adapt and grow? |
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72. How would you rate the Designee's ability to effectively prioritize things? |
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73. How would you rate the Designee's ability to focus on tasks assigned? |
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74. How would you rate the Designee's ability to innovate? |
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75. How would you rate the Designee's public speaking ability? |
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76. How would you rate the Designee's ability to intuitively sense other people's perspectives? |
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77. How would you rate the Designee's ability to express their thoughts and feeling verbally? |
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78. How would you rate the Designee's ability to productively multi-task? |
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79. Overall, how would you rate the Designee's ability to communicate? |
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80. How would you rate the Designee's ability to express their thoughts and feelings in writing? |
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81. How would you rate the Designee's ability to maintain their composure in stressful situations? |
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82. How would you rate the Designee's ability to maintain their composure in stressful situations? |
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83. How would you rate the Designee's ability to overcome adversity? |
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84. How would you rate the Designee's ability to get things done in a timely fashion? |
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85. How would you rate the Designee's internet and computer literacy versus their age group? |
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86. How much international travel has the Designee experienced versus their age group? |
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87. How would you rate the Designee's knowledge of history versus other people? |
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88. How do you rate the Designee's knowledge of politics and government versus other people? |
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89. How much do you follow global events? |
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90. How would you rate the Designee's common sense? |
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91. How would you rate the Designee's ability to see "The Big Picture" of situations? |
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92. How well would you rate the Designee's ability to see "The Big Picture" of life? |
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93. How easy is it for the Designee to admit when they have been wrong about something & apologize if appropriate? |
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94. How would you rate the Designee's emotional health and stability versus other people in general? |
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95. How does the Designee react to constructive criticism? |
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96. How well does the Designee control their temper? |
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97. How does the Designee act when they are very angry with someone? |
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98. How often does the Designee get very angry or hostile toward someone? |
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99. How motivated and goal oriented is the Designee versus their peer group? |
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100. Overall, how open minded is the Designee? |
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101. Given a choice, would Designee rather be right or happy and successful? |
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102. How would you rate the Designee's self-esteem? |
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103. How would your rate the Designee's decisiveness? |
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104. How well does the Designee take responsibility for their own happiness? |
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105. How well does the Designee take responsibility for their own life? |
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106. Is the Designee generally on time? |
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107. Overall, how would you rate the Designee's reliability? |
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108. How well does the Designee function when they are alone in their life? |
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109. How would you rate the Designee's housekeeping habits? |
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110. How would you rate the Designee's emotional maturity level versus their age peer group? |
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111. How would you rate the Designee's patience overall? |
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112. How do you rate the Designee on stubborn versus flexible? |
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113. How well does the Designee manage stress? |
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114. How would you rate the Designee's level of self-discipline? |
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115. How do you rate the Designee's ability to make and keep quality friendships? |
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116. How does the Designee think and make decisions? |
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117. How would you rate the Designee's level of self-motivation? |
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118. Overall, are is the Designee more dependent or independent? |
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119. Overall, how organized is the Designee? |
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120. How set in their ways is the Designee? |
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121. Overall, is the Designee more lazy or energetic? |
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122. How motivated is the Designee to excel and achieve versus their peer age group? |
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123. Generally, is the Designee more inclined to make excuses or get results? |
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124. How important are the Designee's choices to their success in life? |
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125. How important is the Designee's ability to compete to their success in life? |
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126. How would you rate the Designee's personal life judgment overall? |
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127. How would you rate the Designee's professional judgment versus their age peer group? |
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128. Overall, how would you rate the Designee's ability to judge people accurately? |
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129. How would you rate the Designee's financial judgment overall? |
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130. How would you rate the Designee's overall personal judgment with friends in their life? |
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131. How would you rate the Designee's overall personal judgment with their spouse(s) or significant others in their life to date? |
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132. How would you rate the Designee's physical health versus their age group peers? |
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133. How would you rate the Designee's weight versus the optimum for their age group? |
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134. What is the current marital status of Designee? |
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135. How many adopted or step-children does Designee have? |
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136. How many biological children does the Designee have? |
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137. Rate the Designee as a parent. If no children or step-children select 0. |
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138. How would you rate the Designee's overall character versus other people in general? |
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139. How would you rate the Designee's personal courage level overall? |
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140. How would you rate the Designee's trustworthiness versus people in general? |
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141. How would you rate the Designee's conscience? |
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142. How would you rate the Designee's honesty and integrity overall? |
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143. Overall, how would you rate the Designee's generosity? |
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144. Overall, how would you rate the Designee's compassion and empathy for others? |
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145. Overall, how well can the Designee be counted on by others? |
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146. How would you rate the Designee's willingness to help others? |
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147. How do you rate the Designee on selfless versus selfish? |
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148. Overall, how would you rate the Designee as a friend? |
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149. Is the Designee's anger/temper an issue in your life? |
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150. Is the Designee's alcohol consumption an issue in your life? If so, please describe briefly. |
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151. Is the Desinee's non-alcohol substance abuse an issue in your life? If so, please describe briefly. |
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152. Has the Designee had any DWI's or DUI's? |
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153. Is the Designee's physical abuse of anyone an issue in their life? |
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154. Has the designee ever physically harmed someone except in self-defense? If so, please describe briefly |
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155. Is the Designee's verbal or emotional abuse of anyone an issue in their life? |
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156. Have the Designee been physically abused? If so, please describe briefly. |
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157. Has the Designee been verbally or emotionally abused? If so, please describe briefly. |
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158. Is gambling an issue in the Designee's life? |
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159. Is someone else's gambling an issue in the Designee's life? If so, please describe briefly.
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160. Has the Designee's breaking of laws been an issue in their life? If so, please describe briefly.
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161. Has someone else's law breaking been an issue in the Designee's life? |
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162. Is the Designee's reckless spending been an issue in their life? If so, please describe briefly. |
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163. Is someone else's reckless spending an issue in the Designee's life? |
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164. Is the Designee's unemployment an issue in their life? |
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165. Is someone else's unemployment an issue in the Designee's life? |
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166. Has infidelity by the Designee been an issue in their life? If so, briefly describe. |
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167. Has someone else's infidelity been an issue in the Designee's life? If so, please describe briefly. |
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168. Is your dishonesty or untrustworthiness an issue in the Designee's life? |
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169. Is someone else's dishonesty or untrustworthiness an issue in the Designee's life? |
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170. How does the Designee feel about tattoos? |
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171. Please check any issues below that apply to the Designee even if they are infrequent.
The goal is to identify issues to be addressed so it is important to be candid with the Designee.
Note: Select the answers & other if you want to add other issues or comments |
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172. Are there things in the Designee's past that are adversely affecting their life today? |
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173. Are there significant fear factors that affect the Designee's life? |
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174. How would you rate the Designee as a spouse/life partner? ANSWER "I DO NOT KNOW" IF YOU ARE NOT THE DESIGNEE'S SPOUSE OR LIFE PARTNER |
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175. How would you rate the Designee as a lover? ANSWER "I DO NOT KNOW" IF YOU ARE NOT THE DESIGNEE'S SPOUSE OR LIFE PARTNER |
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176. How would you rate the Designee as a friend to you if you are the spouse or significant other of the Designee? CHOOSE "I DO NOT KNOW" if you are not the spouse or significant other of the Designee. |
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177. How would you rate the Designee as a social asset to you if you are the spouse or significant other of the Designee? CHOOSE "I DO NOT KNOW" if you are not the spouse or significant other of the Designee. |
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178. How would you rate the Designee as a professional asset to you if you are the spouse or significant other of the Designee? CHOOSE "I DO NOT KNOW" if you are not the spouse or significant other of the Designee. |
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179. How would you rate the Designee on affection and intimacy with you if you are the spouse or significant other of the Designee? CHOOSE "I DO NOT KNOW" if you are not the spouse or significant other of the Designee. |
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180. How would you rate the Designee on trustworthiness with you if you are the spouse or significant other of the Designee? CHOOSE "I DO NOT KNOW" if you are not the spouse or significant other of the Designee. |
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181. How would you rate the Designee on their willingness to compromise with you if you are the spouse or significant other of the Designee? CHOOSE "I DO NOT KNOW" if you are not the spouse or significant other of the Designee. |
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182. How would you rate the Designee on their willingness to consistently place your relationship above other concerns if you are the spouse or significant other of the Designee? CHOOSE "I DO NOT KNOW" if you are not the spouse or significant other of the Designee. |
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183. How would you rate the Designee's willingness to apologize and seek reconciliation after conflict? |
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184. How would you rate the Designee's willingness to let go of resentments? |
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185. How would you rate the Designee's ability to express their true thoughts and feelings and communicate with you if you are the spouse or significant other of the Designee? CHOOSE "I DO NOT KNOW" if you are not the spouse or significant other of the Designee. |
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186. How would you rate the Designee's ability to offer positive solutions to issues and work to achieve permanent solutions to issues with you. if you are the spouse or significant other of the Designee? CHOOSE "I DO NOT KNOW" if you are not the spouse or significant other of the Designee. |
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187. How would you rate your overall common interests and shared life priorities with the Designee if you are the spouse or significant other of the Designee? CHOOSE "I DO NOT KNOW" if you are not the spouse or significant other of the Designee. |
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188. How would you rate the Designee in making your relationship a top priority and honoring their commitments to you if you are the spouse or significant other of the Designee? CHOOSE "I DO NOT KNOW" if you are not the spouse or significant other of the Designee. |
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189. How would you rate the Designee as a source of support for you if you are the spouse or significant other of the Designee? CHOOSE "I DO NOT KNOW" if you are not the spouse or significant other of the Designee. |
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190. How would you rate the compatibility of you and the Designee on parenting if you are the spouse or significant other of the Designee? CHOOSE "I DO NOT KNOW" if you are not the spouse or significant other of the Designee. |
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191. How would you rate your compatibility with the Designee as a spouse or life partner. CHOOSE "I DO NOT KNOW" if you are not the spouse or significant other of the Designee. |
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192. Is sex a problem in your relationship with the Designee if you are the spouse or significant other of the Designee? CHOOSE "I DO NOT KNOW" if you are not the spouse or significant other of the Designee.your spouse or significant other? If no spouse or significant other now, refer to your last previous relationship. |
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193. How important is a good relationship with a spouse or significant other to Designee's happiness? |
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194. How would you describe Designee's romantic nature? |
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195. Where is sex on Designee's list of priorities? Select more than 1 choice if applicable. If you are not the spouse or significant other of Designee, please choose "I do not know" |
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196. Please rate Designee's personal happiness among Designee's overall life priorities. |
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197. Please rate Designee's spouse's or significant other's happiness among Designee's overall life priorities. |
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198. Please rate Designee's relationship with Designee's spouse or significant other among Designee's life priorities. |
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199. Please rate Designee's children's happiness among Designee's overall life priorities at his point in their lives. |
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200. Please rate Designee's career among Designee's overall life priorities. |
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201. Please rate material things among the Designee's life priorities. |
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202. Please rate friends among the Designee's life priorities. |
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203. Most people have elements of more than one personality profile so please select the personality traits that apply to Designee to some degree.
Then rate the items you chose with a percentage that applies to Designee for each choice you made to reach a total of 100% for all traits. |
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A. Type “A” Personality - Leaders - Entrepreneurial, risk takers, direct, innovative, self-motivated, dislike routine, enjoy change, focused, decisive, persistent, and can be insensitive and impatient. Socially functional because it is a necessity to reach their ambitions, but can turn off other people. Rely on their intellect, leadership qualities and knowledge to succeed. Achieving success is very important.
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B. Type “B” Personality - Socially oriented – Love excitement and to party and travel, enjoy groups, like being center of attention, supportive of friends, want to be liked by others and easily hurt if rejected, good public speakers, talkative, personable, persuasive, outgoing extroverts. Rely more on their personalities than their expertise to succeed. Tend to think more emotionally than rationally. Enjoying life is very important.
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C. Type "C" Personality - Artistic and creative oriented - Usually fashionable or flaky dressers. Enjoy expressing their active imaginations through writing or other artistic expression. Socially interesting but can be reserved. Tend to think more emotionally than rationally. Often have difficulty with analytical thinking and mathematics. Rely on their artistic talents to succeed. Expressing themselves through their art is very important.
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D. Type “D” Personality - Detail and analytically oriented – Precise, organized, consistent, predictable, responsible, thoughtful, slow to make decisions, emotionally sensitive, inquisitive, loyal, and patient. Think more rationally than emotionally. Rely on their expertise to succeed. Can struggle in social settings. Understanding the details is very important.
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E. Type “E” Personality - Status quo lovers – Dislike change, prefer the predictable, enjoy repetitive tasks, security oriented, compassionate of others, happy, punctual and content. Rely on consistent conformity to succeed. Preparing for a great retirement is very important.
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F. Type “F” Personality - Underachievers – Can be very bright, but low self-esteem and/or motivation are obstacles to their life potential. Inward focused and prefer to settle for less in life rather than to aspire for more and have to face the potential for failure. Rely on low self-expectations to avoid dealing with success. Avoiding competition and accountability is very important.
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G. Type “G” Personality - Self destructive – Reject societal expectations, and engage in self-destructive behavior without concern for the adverse effects on their life potential. Every problem they have is someone else’s fault. Success is being a non-conformist. Doing whatever they want is very important.
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List a percentage of each personality type that applies to you to total 100%:
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204. Where would you rate the Designee on the political spectrum? |
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205. How concerned is the Designee about political outcomes in 2012? |
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| 206. Comments/Suggestions: | | |
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| 207. Please release this completed questionnaire to the following person(s) at the listed e-mail address(es): | | |
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