Today's Date  
                                     Month     Day     Year   

Your name
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Please read each statement.  Then CHECK the letter (A,B,C,D, or E) that best describes how much that statement applies to you.                                                                      

1 I ENJOY MYSELF WITH FRIENDS
           -This statement is (choose one)

        A. Very much like me
        B. Somewhat like me
        C. Neither like me or unlike me
        D. Somewhat unlike me
        E. Very much unlike me

2. I MAKE SURE I AM NOTICED BY OTHERS.

        A. Very much like me
        B. Somewhat like me
        C. Neither like me or unlike me
        D. Somewhat unlike me
        E. Very much unlike me

3. I CONSIDER A FRIEND IN NEED A PEST.

        A. Very much like me
        B. Somewhat like me
        C. Neither like me or unlike me
        D. Somewhat unlike me
        E. Very much unlike me

4. I PRAISE MY FRIENDS' ACHIEVEMENTS.

        A. Very much like me
        B. Somewhat like me
        C. Neither like me or unlike me
        D. Somewhat unlike me
        E. Very much unlike me

5. I SOLICIT APPROVAL FROM PEOPLE I KNOW.

        A. Very much like me
        B. Somewhat like me
        C. Neither like me or unlike me
        D. Somewhat unlike me
        E. Very much unlike me

6. HELPING OTHERS IS IMPORTANT TO ME.        

        A. Very much like me
        B. Somewhat like me
        C. Neither like me or unlike me
        D. Somewhat unlike me
        E. Very much unlike me

7. I WILL NOT LAVISH PRAISE ON CLOSE FRIENDS OR 
        FAMILY MEMBERS.

        A. Very much like me
        B. Somewhat like me
        C. Neither like me or unlike me
        D. Somewhat unlike me
        E. Very much unlike me

8. I DO NOT WONDER WHY PEOPLE DO NICE 
         THINGS FOR ME.

        A. Very much like me
        B. Somewhat like me
        C. Neither like me or unlike me
        D. Somewhat unlike me
        E. Very much unlike me

9. I BRAG ABOUT THINGS I HAVE DONE.

        A. Very much like me
        B. Somewhat like me
        C. Neither like me or unlike me
        D. Somewhat unlike me
        E. Very much unlike me

10. I CONTRIBUTE TO WORTHY CAUSES.

        A. Very much like me
        B. Somewhat like me
        C. Neither like me or unlike me
        D. Somewhat unlike me
        E. Very much unlike me

11. I HAVE LITTLE DIFFICULTY SAYING "NO" 
           TO WHAT OTHER EXPECT OF ME.

        A. Very much like me
        B. Somewhat like me
        C. Neither like me or unlike me
        D. Somewhat unlike me
        E. Very much unlike me

12. I AM NOT EMBARRASSED WHEN STRANGERS 
            SMILE AT ME.

        A. Very much like me
        B. Somewhat like me
        C. Neither like me or unlike me
        D. Somewhat unlike me
        E. Very much unlike me

13. I CAN HAVE FUN WITH ALMOST ANYONE.

        A. Very much like me
        B. Somewhat like me
        C. Neither like me or unlike me
        D. Somewhat unlike me
        E. Very much unlike me

14. I DO THE OPPOSITE OF WHAT PEOPLE 
        REQUEST, EVEN THOUGH THEY MAY BE RIGHT.

        A. Very much like me
        B. Somewhat like me
        C. Neither like me or unlike me
        D. Somewhat unlike me
        E. Very much unlike me

15. I DON'T MIND BEING TOUCHED BY PEOPLE I KNOW.

        A. Very much like me
        B. Somewhat like me
        C. Neither like me or unlike me
        D. Somewhat unlike me
        E. Very much unlike me

16. I SHOW MY FEELING PHYSICALLY WHEN 
         GREETING FRIENDS.

        A. Very much like me
        B. Somewhat like me
        C. Neither like me or unlike me
        D. Somewhat unlike me
        E. Very much unlike me

17. I SEEK ENCOURAGEMENT FROM PEOPLE.

        A. Very much like me
        B. Somewhat like me
        C. Neither like me or unlike me
        D. Somewhat unlike me
        E. Very much unlike me

18. I AM OPEN WITH PEOPLE I KNOW.

        A. Very much like me
        B. Somewhat like me
        C. Neither like me or unlike me
        D. Somewhat unlike me
        E. Very much unlike me

19. I SMILE AT STRANGERS.

       A. Very much like me
        B. Somewhat like me
        C. Neither like me or unlike me
        D. Somewhat unlike me
        E. Very much unlike me

20. I AVOID EYE CONTACT WITH PEOPLE 
          DURING CONVERSATIONS.

        A. Very much like me
        B. Somewhat like me
        C. Neither like me or unlike me
        D. Somewhat unlike me
        E. Very much unlike me

21. I ENJOY ATTENTION FROM OTHERS.

        A. Very much like me
        B. Somewhat like me
        C. Neither like me or unlike me
        D. Somewhat unlike me
        E. Very much unlike me

22. I LOOK FOR RECOGNITION FROM OTHERS.

        A. Very much like me
        B. Somewhat like me
        C. Neither like me or unlike me
        D. Somewhat unlike me
        E. Very much unlike me

23. I TURN DOWN REQUESTS FROM FRIENDS 
         WITHOUT A SECOND THOUGHT.

        A. Very much like me
        B. Somewhat like me
        C. Neither like me or unlike me
        D. Somewhat unlike me
        E. Very much unlike me

24. I MANIPULATE PEOPLE TO MY ADVANTAGE.

        A. Very much like me
        B. Somewhat like me
        C. Neither like me or unlike me
        D. Somewhat unlike me
        E. Very much unlike me

For active counseling clients: 
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