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Questionnaire

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Personal Introductory Questionnaire

(c) Steve Banhegyi, 2000  (You can also download this questionnaire here). You can use the questionnaire in one of two ways: Fill it out yourself and do a little thinking or fill it out and email it back to me. I'll  have a look and maybe give you some ideas and pointers.

Name  
Date of Birth  
Place of Birth  

Parents

Mothers Name  
Mothers DOB  
Fathers Name  
Fathers DOB  
What was your mother like as a person?  
What was your father like as a person  
Describe your parents' relationship - how did they relate to each other  
Objectively, whose behavioural traits do you have most of - your Mother's or Father's?  
DId your parents get divorced?  
Describe your relationship with your mother at the moment.  
Describe your relationship with your father at the moment.  

Mentors

Describe any important people in your formative years. Note that the experiences with these people don't necessarilly have to have been positive.   

Environment

Did you move home as a child? How often?  
Give Details of moves and your age at the time  
How did you feel about moving ?  

Education - Primary & High School

How old were you when you first attended Creche or Nursery School?  
Do you remember anything about those years? If so, please Comment  
Give details of school attended and how you felt about school this should include schoolwork, playground activities, extra murals and sport  
Please give details of schools attended and how you felt about school. This should include schoolwork, playground activities, extra murals and sport. Please give details as above including Subjects chosen for final years ("A" levels, Matric etc.)  
Did you have a nickname at school and if so, what was it?  
Were school years the best years of your life? Give reasons.  
Were you given recognition at school for academics / cultural activities?  
Which sports did you participate in at school. Did you enjoy them?  
Do you participate in any sport now?  

Education - Tertiary

Please give details of Universities or colleges attended, courses taken and qualifiecations achieved  
Please state any adult-study courses or ongoing education programmes that you may be or have been involved in  
Detail interests you had or are currently involved in   
Position held now
Are you happy in your chosen career?  
Do you have future career goals?  
How do you intend to reach your future career goals?  

Beliefs / Philosophy

Who do you admire most and why? This can be any person, living or dead.  
Do you believe in God?  
Do you believe in an afterlife?  
Does life hold meaning for you?  

Medical History

 

Please detail any illnesses or injuries which you may have had.  
Are you taking any drugs at the moment - Perscription or otherwise. Please detail.  

Marriage / Relationships

Marriage / Relationship status  
For how long have you been in this relationship?  
Have you ever had an affair and have you ever spoken to your partner about this affair?  
Please describe your partner.  
What does the relationship feel like?  
What do you fight about and how often?  
Are there secrets between you?  
How does the relationship differ from your expectations?  
Please give details of previous marriages or close / committed relationships. How long did they last, also detail the reasons why they did not last  
Do you fantasise about having relationships with others? Are there recurring fantasies involving particular people?  

Feelings

Do you feel alone from time to time?  
Do you experience depression?  
Do you get angry and, if so, under what circumstances?  
What makes you laugh?  
Do you feel different? How?  
What makes you cry?  
Are you safe and secure?  
Do you have fears? Of what?  
Are you affectionate?  

Perceptions

Do people seek out your company?  
Do others see you as being safe and secure?  
Do you have the power to change things?  
Do you get your own way most of the time?  
How do people see you?  
What strategies do you have for getting your own way?  
How would you describe yourself?  
How would your partner / Wife / Husband describe you?  
How would your best friend describe you?  
How would your worst enemy describe you?  

Organisational Experiences

What made you feel fulfilled and happy in the jobs you have held previously?  
What made you feel frustrated in the jobs you have held previously?  
What experiences have you had which you can share with others in your organisation?  
Describe your ideal job - what woiuld you be doing if you worked at your ideal job?  
If money were no object, what would you be doing now?  

Goals and Dreams

What did you want to be when you were small?  
What do you want to be now?  
Do you make things happen or do you wait for things to happen?  
If you could do anything right now, what would you be doing?  
Are you in control most of the time? What happens when you are not?  
Are you living in your power right now?  
Have you answered all questions honestly here?  
 
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