Assessment Questionnaire
forIVTOM The Singer’s Path to Peak Performance
The following questionnaire is designed to provide Dr. Skidmore the information he needs regarding your past experiences, current attitudes, and goals relating to performing so that he can best support you on your quest to be a peak performer. Please answer all the questions honestly and as best you can. If you’re not sure what a question is asking, just give it your best shot—there are no wrong answers!
If you received this questionnaire as a computer file, you can fill in the answers using Microsoft Word. Just click in the fields highlighted in gray and type your answers, or click on a check box to check it. You can also tab between fields and check boxes.
PART IHistory and Goals
Today’s Date:
Your Name: Age:
Address:
City: State:
ZIP or Postal Code: Country:
Home phone: Cell phone: E-mail:
Level of Education: High school 2-year college degree
4-year college/conservatory Master’s degree Doctor’s degree
Name of Current School:
Complete the following questions as best you can.
1.At what age did you start singing?
2.What other instruments do you play?
3.How many years have you taken lessons?
4.Are you also a teacher? What do you enjoy about teaching?
5.Describe what you liked about your favorite teacher.
6.Describe what you disliked about your least favorite teacher.
7.Describe three areas you would like to focus on as part of yourcoaching experience.
a.
b.
c.
8.List three goals you have for your futureas a singer.
a.
b.
c.
9.List three concerns you have about your future as a singer.
a.
b.
c.
10.List three goals you have for yourself personally.
a.
b.
c.
11.List three concerns you have for yourself personally.
a.
b.
c.
12.List three words you would use to describe yourself when you are at your best.
a. b. c.
13.List three words you would use to describe yourself when you are “down” or concerned.
a. b. c.
14.List three words you would use to describe yourself when you are stressed or anxious.
a. b. c.
15.If you could wave a magic wand over a part or aspect of your experience as a performer and just make it disappear what would it be?
16.Briefly describe a great performance you have had.
17.What three words best describe that performance?
a. b. c.
18.Briefly describe a “disastrous” or disappointing performance you have had.
19.What three words best describe that performance?
a. b. c.
20.Describe your typical pre-performance experience by answering these questions.
How do you know when you are prepared?
What do you like to do to get into your “I am the singer” character pre-performance.?
How do you deal with any negative or distracting thoughts?
How do you deal with any performance anxiety?
How do you approach the day of the performance?
Describe what you do and what it is like just before you step out on stage.
What do you typically do after the performance?
PART IIPerformance Attitude Questionnaire
Complete the following sentences. Just put down whatever comes to mind.
Performing is …
When I sing…
I get embarrassed when …
I wish I could …
I get stressed out when …
Right before a performance I …
A disappointing performance …
When I perform well I feel …
Practicing for my voice lesson …
On the day of the performance I …
What I like most about singing is …
Auditions are …
What I like least about singing is …
When I see a video of me performing I …
The audience …
Mistakes are …
Singing in front of judges …
I know my voice is tired when …
I would feel more comfortable on stage if…
My weakness …
I am at my best when …
I feel about this coming year.
I relax by …
I …
My family …
I lose my motivation when …
My vocal health …
When I perform I expect …
My voice coach …
I hope …
I take care of myself by …
When I have free time I …
I get angry when …
I get frustrated when …
I enjoy …
The most important thing for me as a singer is …
My sound …
My big dream …
Memorization …
My future as a performer …
Sight-reading …
Expressing emotion while performing …
My voice …
My skill level …
Other people tell me my voice …
Performing for friends …
Performing for a large audience …
One aspect of my sound that I am working on….
I am most confident performing …
My physical appearance on stage …
I feel the most pressure when …
When I hear a recording of myself I …
If only I could …
My next step forward as a performer is …
Criticism …
Compliments …
Having an agent/manager…
Three steps to understanding the Performance Attitude Questionnaire
- Go back and read each sentence and ask yourself whether it reflects a positive or a negative attitude. On the dash in front of each sentence place a P for positive or an N for negative.
- Review all of the negative responses or attitudes. Write down what you feel are the three most limiting or problematic attitudes that you identified in this questionnaire.
a.
b.
c.
3. Look at each of the three negative attitudes listed above. Now look at the negative attitude and
re-write it into a performance-promoting or positive attitude.
a.
b.
c.
PART IIIPerformance Profile
This section explores 25 different aspects of your experience as a performer. Read each question and reflect on your personal experience.
Answer each sentence as True, False or Sometimes.
1. I feel excited and ready before I perform.
2. I effectively manage performance anxiety.
3. I have goals for my performing.
4. I cope well with mistakes or breakdowns during performances.
5. I look forward to performing for the audience.
6. I rarely get distracted when I perform.
7. I enjoy performing solo.
8. I refocus quickly if I get distracted.
9. I feel confident about my performance preparation.
10. I memorize well.
11. I never critique my performance while I am singing.
12. I accept mistakes as part of the learning process.
13. I take advantage of performing opportunities.
14. I sleep well the night before a performance.
15. I rarely think about previous “bad” or “embarrassing” performances.
16. I intentionally plan and organize my performance preparation.
17. I am healthy.
18. I consistently warm up as part of my practice and performance.
19. I usually feel satisfied after I perform.
20. I never take medication for performance-related pain.
21. I usually expect the best when I perform.
22. My self-talk (what I say to myself about my performing) is positive.
23. I use pre-performance routines before I perform.
24. I have confidence in my ability to consistently perform well.
25. I use positive visualization to prepare myself mentally for a performance.
PART IVPerformance Skills
This questionnaire looks at your self-rating of the 9 psychological skills of peak performance. It starts at 0 and ends at 10. A ten is “it can’t get any better.” Rate your ability to use this skill to support your performing as you see yourself today.
1 / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9 / 101.Confidence as a performer
2.Goal setting and achievement
3.Attention focus and control
4.Positive visualization
5.Attitude management
6.Stress/Anxiety management
7.Positive self-talk/Optimism
8.Mental Preparation for performance
9.Willingness to learn from each performance
PART VHealth Concern Screening—Confidential
Name: ______ Age: _____ Date: ______
YesNo
1.Are you currently under a doctor’s care? If yes, for what?
2. Are you currently taking medications or supplements? Please list:
3.Do you have or have you had any health related problems with your voice? Please describe.
4.Do you think you are depressed?
5.Do you often feel overwhelmed by the stress of life?
6.Do you exercise on a regular basis?
If yes, what do you do?
If no, briefly explain your reason:
7.Is controlling your emotions a problem?
8.Are drugs or alcohol currently causing problems in your life?
9.Do you have chronic pain? If yes, where?
10.Do you have difficulty sleeping?
11. Is there something that you know you need to be doing to support your health and wellbeing that you are avoiding?If yes, please explain:
PART VIConsultation with Dr. Skidmore
Here’s how you can best prepare for your consultation with Dr. Skidmore:
1.Complete every question on Parts I through V of this questionnaire.
2.E-mail the completed questionnaire to me before our appointment.Email:
Ben I am looking forward to supporting you on your quest for greatness on stage.
Find Your Sandbox and Sing!
Jon Skidmore, Psy.D.
Performance Coach & Licensed Psychologist
“Performing is a testament of your love for music,not a test of who you are!” Mark Baxter
Copyright 2017Jon Skidmore, Psy.D. All rights reserved. Page 1 of 13