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Instructions: Below, you will find a series of questions that revolve around your perception of yourself. Each question is followed by a set of 6 possible categories: family, friends, social groupings, school/department peers, humanity in general, and personal self.
Social groupings could be any of the following: political group/party, government institution, or religious affiliation.
Make sure to read each question carefully. Thank you.

Scale use:
You are asked to mark, from a low of 1 to a high of 7 the frequency/magnitude that most reflects your response to each question. Please respond to each question AND to each item within that question

 
 
I think of myself as connected (linked) to:
To a very small extent (1) To a small extent (2) In between small and moderate extent (3) To a moderate extent (4) In between moderate and large extent (5) To a large extent (6) To a very large extent (7)
My family
My friends
Students in my department/major
My social grouping
Humanity in general
Myself (I am an unique person separate from others)
 
 
I control my behavior to accommodate the wishes (interests) of:
To a very small extent (1) To a small extent (2) In between small and moderate extent (3) To a moderate extent (4) In between moderate and large extent (5) To a large extent (6) To a very large extent (7)
My family
My friends
Students in my department/major
My social grouping
Humanity in general
Myself (I act as an independent person)
 
 
I am affected by events that concern (relate) to:
To a very small extent (1) To a small extent (2) In between small and moderate extent (3) To a moderate extent (4) In between moderate and large extent (5) To a large extent (6) To a very large extent (7)
My family
My friends
Students in my major/department
My social grouping
Humanity in general
Myself
 
 
I am aware of the needs, desires and goals of:
To a very small extent (1) To a small extent (2) In between small and moderate extent (3) To a moderate extent (4) In between moderate and large extent (5) To a large extent (6) To a very large extent (7)
My family
My friends
Students in my department/major
My social grouping
Humanity in general
Myself
 
 
I feel I have a strong relationship with:
To a very small extent (1) To a small extent (2) In between small and moderate extent (3) To a moderate extent (4) In between moderate and large extent (5) To a large extent (6) To a very large extent (7)
My family
My friends
Students in my major/department
My social grouping
Humanity in general
Myself (I am an independent person)
 
 
Scoring
Add the values for each group and divide by 5, then round off to the nearest whole number. Check the whole number in the matrix.
1 2 3 4 5 6 7
My family
My friends
Students in my department/major
My social grouping
Humanity in general
Myself
 
 
 
Gender
   
Age
   
Ethnic group
   
Religion
   
Major
   
Where did you live prior enrolling in university?
   
While attending university, are you living at home, in an apartment, or on campus?
   
How many times do you go home every month?
   
 
 
 
Members in your family that are living with you
 
father
 
mother
 
grandfather
 
grandmother
 
siblings
 
cousins
 
Other
 

 
 
 
Where did you get your financial support? (Select all that applies to you)
 
family
 
part time job
 
scholarship
 
Other
 

 
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