Self-Worth and Connection Survey
Help us understand your experiences with self-worth and social connectedness. Your responses are confidential and will be used to improve support and resources.
Your Age
*
Gender
*
Female
Male
Non-binary / Third gender
Prefer not to say
Other
How strongly do you agree or disagree with the following statements?
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I feel good about myself.
1
2
3
4
5
I feel that I am a person of worth.
6
7
8
9
10
I feel accepted by others.
11
12
13
14
15
I feel connected to people around me.
16
17
18
19
20
I have people I can rely on.
21
22
23
24
25
How would you rate your overall self-esteem?
*
1
2
3
4
5
How often do you feel lonely?
*
Never
Rarely
Sometimes
Often
Almost always
Who do you turn to for support when needed? (Select all that apply)
*
Family
Friends
Partner/Spouse
Coworkers/Classmates
Support groups
No one currently
Other
How satisfied are you with your current social connections?
*
Not at all satisfied
1
2
3
4
5
6
7
8
9
Extremely satisfied
10
1 is Not at all satisfied, 10 is Extremely satisfied
Do you participate in any community or group activities?
*
Yes, regularly
Occasionally
Rarely
Never
What helps you feel more connected to others? (Select all that apply)
*
Spending time with friends/family
Participating in group activities
Online communities/social media
Volunteering
Sharing personal experiences
Other
In your own words, describe a time when you felt a strong sense of self-worth or connection.
Is there anything else you'd like to share about self-worth or connection?
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