Case #______

Sample Questionnaire

Self Esteem Study

1. What is your gender? (circle one)
f Female
mMale

2. What is your age in years? ____

3. What is the highest level of education that you have completed? (circle one number)

1No formal education2Some grade school3Completed grade school Skip to Question 5.4Some high school5Completed high school6Some college7Completed college8Some graduate workPlease answer Question 4.9A graduate degree

4. If you have attended college, what was your most recent major?

______

5. What is your height? _____ feet _____ inches

Please indicate your level of agreement with the following statements (check one box for each statement): / Strongly
Disagree
(1) /
Disagree
(2) /
Agree
(3) / Strongly Agree
(4)
6. I feel that I’m a person of worth, at least on an equal basis with others. /  /  /  / 
7. I feel that I have a number of good qualities. /  /  /  / 
8. All in all, I am inclined to feel that I am a failure. /  /  /  / 
9. I am able to do things as well as most other people. /  /  /  / 
10. I feel I do not have much to be proud of. /  /  /  / 

Self-Esteem Study Codebook

VARIABLE NAME / FORMAT / DESCRIPTION / VARIABLE LABEL / CODED VALUE / VALUE LABEL
CASENO / Numeric
Width = 3
Decimals = 0
/ Case number
Case number
SEX / String
Width = 1 / 1. What is your gender?
f Female
m Male
AGE / Numeric
Width = 2
Decimals = 0
/ 2. What is your age in years?
(Code actual age in years.)
EDUC / Numeric
Width = 1
Decimals = 0 / 3. What is the highest level of education that you have completed?
Education level|
1 No formal education
2 Some grade school
3 Completed grade school
4 Some high school
5 Completed high school / 6 Some college
7 Completed college
8 Some graduate work
9 A graduate degree
MAJOR / String
Width = 25 / 4. If you have attended college, what was your most recent major?
Most recent college major
HT_FEET / Numeric
Width = 1
Decimals = 0
/ 5. What is your height?
Height in feet
HT_INCH / Numeric
Width = 4
Decimals = 1
/ 5. What is your height?
Height in inches
ESTEEM1 / Numeric
Width = 1
Decimals = 0 / 6. I feel I am a person of worth, at least on an equal basis with others.
I am a person of worth
1 Strongly disagree
2 Disagree
3 Agree
4 Strongly agree
(Use the same codes as above for all ESTEEM items below.)
ESTEEM2 / Numeric
Width = 1
Decimals = 0
/ 7. I feel that I have a number of good qualities.
I have good qualities
ESTEEM3 / Numeric
Width = 1
Decimals = 0 / 8. All in all, I am inclined to feel that I am a failure.
I am a failure
(Reverse codes before computing overall self esteem score.)
ESTEEM4 / Numeric
Width = 1
Decimals = 0
/ 9. I am able to do things as well as most other people.
I can do things as well
ESTEEM5 / Numeric
Width = 1
Decimals = 0 / 10.I feel I do not have much to be proud of.
I am not proud
(Reverse codes before computing overall self esteem score.)