Hierarchy of Human Needs Questionnaire
Survival:
Sustainable physical health:
Rank
1
2
3
4
5
6
7
8
9
10
Action plan:
Notes: thoughts, celebration, problems and areas I need help.
Safe, warm sustainable shelter:
Rank
1
2
3
4
5
6
7
8
9
10
Action plan:
Notes: thoughts, celebration, problems and areas I need help.
Access to nourishing food:
Rank
1
2
3
4
5
6
7
8
9
10
Action plan:
Notes: thoughts, celebration, problems and areas I need help.
Access to medical care as needed:
Rank
1
2
3
4
5
6
7
8
9
10
Action plan:
Notes: thoughts, celebration, problems and areas I need help.
Currency to easily trade:
Rank
1
2
3
4
5
6
7
8
9
10
Action plan:
Notes: thoughts, celebration, problems and areas I need help.
Security:
Legal sanctuary:
Rank
1
2
3
4
5
6
7
8
9
10
Action plan:
Notes: thoughts, celebration, problems and areas I need help.
Retirement investments:
Rank
1
2
3
4
5
6
7
8
9
10
Action plan:
Notes: thoughts, celebration, problems and areas I need help.
Savings:
Rank
1
2
3
4
5
6
7
8
9
10
Action plan:
Notes: thoughts, celebration, problems and areas I need help.
Free of consumer debt:
Rank
1
2
3
4
5
6
7
8
9
10
Action plan:
Notes: thoughts, celebration, problems and areas I need help.
Logistics in place to secure survival:
Rank
1
2
3
4
5
6
7
8
9
10
Action plan:
Notes: thoughts, celebration, problems and areas I need help.
Love and Belonging:
Self awareness:
Rank
1
2
3
4
5
6
7
8
9
10
Action plan:
Notes: thoughts, celebration, problems and areas I need help.
Self love and understanding of self:
Rank
1
2
3
4
5
6
7
8
9
10
Action plan:
Notes: thoughts, celebration, problems and areas I need help.
Ability to be seen, understood with acceptance:
Rank
1
2
3
4
5
6
7
8
9
10
Action plan:
Notes: thoughts, celebration, problems and areas I need help.
Social skills:
Rank
1
2
3
4
5
6
7
8
9
10
Action plan:
Notes: thoughts, celebration, problems and areas I need help.
Able to see, understand and attune to others:
Rank
1
2
3
4
5
6
7
8
9
10
Action plan:
Notes: thoughts, celebration, problems and areas I need help.
Sexuality with others as desired:
Rank
1
2
3
4
5
6
7
8
9
10
Action plan:
Notes: thoughts, celebration, problems and areas I need help.
Integrating the dissociated and shadow aspects of self:
Rank
1
2
3
4
5
6
7
8
9
10
Action plan:
Notes: thoughts, celebration, problems and areas I need help.
Having the facets of self one loves accepted and nurtured by others:
Rank
1
2
3
4
5
6
7
8
9
10
Action plan:
Notes: thoughts, celebration, problems and areas I need help.
Self Esteem:
Having clear principles:
Rank
1
2
3
4
5
6
7
8
9
10
Action plan:
Notes: thoughts, celebration, problems and areas I need help.
Having clear ideals:
Rank
1
2
3
4
5
6
7
8
9
10
Action plan:
Notes: thoughts, celebration, problems and areas I need help.
Disciplining one's behavior to be consistent with stated ideals and principles:
Rank
1
2
3
4
5
6
7
8
9
10
Action plan:
Notes: thoughts, celebration, problems and areas I need help.
Making incremental progress:
Rank
1
2
3
4
5
6
7
8
9
10
Action plan:
Notes: thoughts, celebration, problems and areas I need help.
Discovering and developing gifts:
Understanding what feeds the inner self:
Rank
1
2
3
4
5
6
7
8
9
10
Action plan:
Notes: thoughts, celebration, problems and areas I need help.
Connecting with inner motivation:
Rank
1
2
3
4
5
6
7
8
9
10
Action plan:
Notes: thoughts, celebration, problems and areas I need help.
Discipline to practice and develop valuable skills:
Rank
1
2
3
4
5
6
7
8
9
10
Action plan:
Notes: thoughts, celebration, problems and areas I need help.
Bringing those gifts abundantly into the larger world:
Creating needed alliances and partnerships:
Rank
1
2
3
4
5
6
7
8
9
10
Action plan:
Notes: thoughts, celebration, problems and areas I need help.
Giving a shape to our gifts that is valuable to others:
Rank
1
2
3
4
5
6
7
8
9
10
Action plan:
Notes: thoughts, celebration, problems and areas I need help.
Connecting with others to share our gifts:
Rank
1
2
3
4
5
6
7
8
9
10
Action plan:
Notes: thoughts, celebration, problems and areas I need help.
Bringing more and more value into the world with our gifts:
Rank
1
2
3
4
5
6
7
8
9
10
Action plan:
Notes: thoughts, celebration, problems and areas I need help.
Becoming part of something bigger than self:
Recognizing and awakening to a larger sense of self:
Rank
1
2
3
4
5
6
7
8
9
10
Action plan:
Notes: thoughts, celebration, problems and areas I need help.
Serving that self by sacrificing aspects of personal identity to serve a larger ideal:
Rank
1
2
3
4
5
6
7
8
9
10
Action plan:
Notes: thoughts, celebration, problems and areas I need help.
Dedicating increasing amounts of time, money and attention to giving to the larger ideal:
Rank
1
2
3
4
5
6
7
8
9
10
Action plan:
Notes: thoughts, celebration, problems and areas I need help.
Transcending our ego through adult love and grace as we blossom into something bigger than our original sense of self:
Rank
1
2
3
4
5
6
7
8
9
10
Action plan:
Notes: thoughts, celebration, problems and areas I need help.
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