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  • Questionnaire Doc in Beige Brown Classic Professional Style

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    Abigail Malon Paclar
    9 views2 pages
    This document is a survey questionnaire that collects general information from respondents. It asks for the respondent's name, age, gender, and occupation. It then presents a series of statements about social anxiety and asks respondents to indicate how often each statement applies to them. Finally, it asks respondents for preferred contact methods to stay in touch and provides contact information for the organization administering the survey.

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    This document is a survey questionnaire that collects general information from respondents. It asks for the respondent's name, age, gender, and occupation. It then presents a series of statements about social anxiety and asks respondents to indicate how often each statement applies to them. Finally, it asks respondents for preferred contact methods to stay in touch and provides contact information for the organization administering the survey.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    9 views2 pages

    Questionnaire Doc in Beige Brown Classic Professional Style

    Uploaded by

    Abigail Malon Paclar
    This document is a survey questionnaire that collects general information from respondents. It asks for the respondent's name, age, gender, and occupation. It then presents a series of statements about social anxiety and asks respondents to indicate how often each statement applies to them. Finally, it asks respondents for preferred contact methods to stay in touch and provides contact information for the organization administering the survey.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 2

    Survey

    Questionnaire
    General Information

    Name (optional):

    Age:

    Gender:

    Occupation:

    Check the box if you agree or disagree

    Statement Never Rarely Some- Often Very Often

    times

    1. Do you feel ​
    ​
    ​
    ​
    ​

    anxious or
    panicky before
    social situations?

    Make sure the ​


    ​
    ​
    ​
    ​

    statement is clear and


    concise.

    Add more rows as ​


    ​
    ​
    ​
    ​

    needed.

    Tick the box that corresponds to your preferred option

    1. Write a question here


    Option 1
    Option 2
    Option 3
    Option 4
    2. Write another question here
    Option 1
    Option 2
    Option 3
    Option 4
    3. Write another question here
    Option 1
    Option 2
    Option 3
    Option 4

    Feedback

    Give your audience the chance to express themselves. There might be details important to them that the
    questionnaire may have missed. An essay format works best for these instances.

    Can we keep in touch?

    If you're open to corresponding with us after this survey, please let us know how best to
    reach you! (This is optional, and we are committed to protecting your data.)

    Via email: Please add your email address here


    Via phone: Please add your contact number here
    Via social media: Please add your social media handle here

    Thank you for your time!

    GiveDirectly
    P.O. Box 3221, New York, NY 10008

    +1 (646) 504-4837

    www.givedirectly.org

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