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What is your name, age, and occupation?
   
 
 
 
Where do you shop for clothes? (Two or three is fine.)
   
 
 
 
What magazines do you read, if any? (Two or three is fine.)
   
 
 
 
What television shows do you watch?
   
 
 
 
What is society's definition of beauty?
   
 
 
 
What is your definition of beauty?
   
 
 
 
What percentage of images in magazines and advertisements do you think are photo manipulated (photoshopped)?
 
100%
 
75%
 
50%
 
25%
 
None
 
Other
 
 
 
 
Do you think that the media is effecting how teenagers and young girls feel about themselves? What about women in their 20's and 30's? Women 40 and older? (Think about eating disorders and plastic surgery.)
   
 
 
 
List some women that you look up to. Why do you look up to them? (These can be famous women, or just women you know.)
   
 
 
 
Do you think you are beautiful? Do you think the media has had an effect on your self esteem? Your self image?
   
 
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