The (Stupid) Questionnaire

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Name ________________________     (You may remain anonymous if you wish)

Date _______________


...Basically, HOW DO YOU PERCEIVE ___________________________?

This questionnaire was designed to give the above-named individual specific information about how you perceive him/her. Your honest responses are being solicited to add a new dimension to his/her self-growth and self-understanding. The purpose is not to flatter nor to unfairly criticize, but merely to share that point-of-view about this person which is uniquely your own. This individual is interested in what you have to say and he/she is fully ready, able, and willing to accept the complete and raw truth, reactions, and consequences. He/she does not expect any certain answers nor does he/she want this information so that he/she can adapt/mold to someone else's blueprint. Caring about what other people think and their perceptions is not the same as worrying about it or fearing it. Remember, the truth is wanted. There is no point in dishonest responses.

Therefore, please answer the questions as truthfully and completely as you can. Feel free to add any information you would like, especially to the "yes/no" structured questions. Especially if there are any questions that you feel particularly strongly about, positively or negatively, please comment. (For longer comments, use the space at the end of this inventory.) Try not to leave any blank. If you do not wish to answer something, please so state and if possible, why (e.g., not having enough information, not wanting to discuss it because it evokes painful memories). And if you recognize that your feelings for this individual at this particular time are not representative of how you usually feel or if they are unusually influenced by what is happening in your own life, please put the inventory aside for a few days or answer whatever you comfortably can and explain how other responses might be uncharacteristically slanted (e.g., you might want to indicate "cruel" or "evil" as descriptive adjectives in Number 1, but you want to state that you generally don't feel that way and think you do now just because he/she just ran over your dog).

Your cooperation in this venture is greatly appreciated. Should you elect not to complete the questionnaire, please refer to question Number 49 and answer it as best you can. Otherwise, take this opportunity to say what is on your mind and in your heart to help this person become a better person. When you have finished, please return the questionnaire (directly to the subject person) in the enclosed, self-addressed envelope. Thank you.

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