This is a questionnaire designed to measure your attitudes and behaviors with respect to people with disabilities. For the purpose of this research, a disability is any condition which society defines as making it more difficult for a person to have a fulfilling life. Included are such situations as paralysis, loss of sight or hearing, and significant mental or emotional disabilities.

Please answer these questions as accurately as you can. This process is anonymous, which means that no one will know what your answers are. This is research which is being done for demonstration purposes in the course Data Analysis for Social Work.

Thank you,
John Sanborn

Please indicate the extent to which you agree or disagree with the following statements by circling the response which matches your opinion.

	Strongly Agree  Agree Undecided Disagree Strongly Disagree
1. My heart goes out to people in wheelchairs.	SA  A  U  D  SD
2. I feel sympathetic toward people who are visually disabled.	SA  A  U  D  SD
3. I assume that people with disabilities deserve special consideration.	SA  A  U  D  SD
4. I am more understanding of physical or sensory disabilities than emotional ones.	SA  A  U  D  SD
5. People who look or act differently scare me.	SA  A  U  D  SD
6. I sometimes think that people who claim to have emotional problems are faking it.	SA  A  U  D  SD
7. I sometimes feel that people with disabilities have been punished by God for something they did.	SA  A  U  D  SD
8. I tend to talk with people with disabilities in a different tone of voice.	SA  A  U  D  SD
9. I tend to be more patient with people with disabilities.	SA  A  U  D  SD
10. I get angry more quickly at people with disabilities.	SA  A  U  D  SD

Please answer the following questions with a Yes or No.

11. I have at some point in my life done something which has been very helpful for a person with a disability.	_____Yes _____No
12. I have at some point in my life teased or otherwise done something to hurt a person with a disability.	_____Yes _____No
13. I have done volunteer work with people with disabilities.	_____Yes _____No
14. I have been employed in a position which involves helping people with disabilities.	_____Yes _____No
15. I have gone to school with people with disabilities.	_____Yes _____No
16. I have a friend or friends with obvious disabilities.	_____Yes _____No
17. I have a family member with an obvious disability.	_____Yes _____No

18. I myself have a disability.	_____Yes (If yes, please go to question 19)
	_____No (If no, please go to question 21)

19. My disability is: (Please check as many as apply)

_____Behavioral (such as impulse control or addiction)
_____Emotional (including depression, anxiety disorder or schizophrenia)
_____Learning (such as ADD, ADHD or dyslexia)
_____Mental (including memory loss or other cognitive impairment)
_____Physical (paraplegia, hemiplegia, quadriplegia, loss of function)
_____Sensory (visual, hearing, tactile impairment)

20. My disability has been a very significant issue in my life.

_____Yes _____No

Now we need to know a few characteristics of the people who have participated in this research. Remember, there is no way I will know your identity from these answers.

21. Gender: _____Female _____Male

22. Age: ___________

23. Major: ________________________________________

24. Marital status: _____Single _____Married _____Separated/Divorced _____Widowed

25. Please use the back of this page to explain any of your answers that you wish to explain or make any other comment about this topic.

Thank you for your help.