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peer post-test 03

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					                                      Peer Educator Survey

       We're glad that you decided to become a peer educator. Please take a few minutes to
complete the following questionnaire. This information will help us understand how being a
peer educator affects the personal and professional development of students.

We would like for you to make a confidential ID number. We are interested in finding out if
your answers on this survey change over time. We want to assure you that your answers are
totally anonymous. We have worked out a system for you to create an ID number:

On this line ________ Please write an A if you are an ADAPT peer educator and a P if you are a
PAW peer educator.

On this line ________ Please write the first letter of the city in which you were born.

On this line ________ Please write the last digit of your social security number.

On this line ________ Please write the first letter of your middle name.

On this line ________ Please write the last digit of the your student number.

Combining the above items your secret ID is:

________/________/________/________/________
letter  / letter / number / letter / number


1. Age: ________

2. Gender:
      _____ Female
      _____ Male

3. How many years have you been an ADAPT/PAW peer educator? ________

4. How active a role would you like to have in ADAPT and the Wellness Resource Center this
   year?
      _____ Very active
      _____ Quite active
      _____ Somewhat active
      _____ A little active

5. What motivated you to become a peer educator?
6. What are your goals and objectives for yourself as a peer educator?




In the following sections, read each statement and rate your satisfaction with your abilities by
circling a number between 1 and 5. One means that you are not satisfied with your ability and
five means that you are very satisfied with your ability.

Interpersonal skills

                                            Not                   Moderately                    Very
                                          Satisfied                Satisfied                   Satisfied
7. I maintain a positive working
   relationships with others.                1            2              3           4             5

8. I give credit to others
   for their input.                          1            2              3           4             5

9. I handle conflicts in an
   assertive manner.                         1            2              3           4             5

10. I am empathetic to the
    needs, feelings and concerns of
    others.                                  1            2              3           4             5

11. I work effectively in a group.           1            2              3           4             5

Management skills

12. I am an effective leader.                1            2              3           4             5

13. I delegate duties to other members
    of my group.                             1            2              3           4             5

14. I work effectively with advisors,
    supervisors, and administrators.         1            2              3           4             5

15. I take initiative when I believe it
    is necessary.                            1            2              3           4             5
16. I seek opportunities for collaboration.   1       2       3        4      5

17. I use my creativity to develop new
    ideas or events.                          1       2       3        4      5

18. I can promote and market ideas
    or events.                                1       2       3        4      5

Communication skills

                                            Not           Moderately        Very
                                          Satisfied        Satisfied       Satisfied
19. I prepare thoroughly before
    giving a presentation                     1       2       3        4      5

20. I can present ideas effectively
    in formal presentations.                  1       2       3        4      5

21. I can effectively conduct group
    discussions.                              1       2       3        4      5

22. I listen carefully.                       1       2       3        4      5

23. I ask for clarification when necessary.   1       2       3        4      5

24. I give constructive feedback to
    others.                                   1       2       3        4      5

25. I make valuable contributions to
    group discussions.                        1       2       3        4      5



Diversity

                                            Not           Moderately        Very
                                          Satisfied        Satisfied       Satisfied
26. I appreciate people with different
    ethnic backgrounds than my own.           1       2       3        4      5

27. I appreciate people of different
    gender than my own.                       1       2       3        4      5

28. I appreciate people with different
    sexual orientations than my own.          1       2       3        4      5
29. I appreciate people with religious
    beliefs different than my own.                1        2       3        4      5

30. I have examined my own identity
    (e.g., values, beliefs, and unique
    characteristics).                             1        2       3        4      5

31. I understand my own biases and
    prejudices.                                   1        2       3        4      5

32. I maintain an open mind regarding
    ideas that are different than my own.         1        2       3        4      5



Problem-solving skills

                                                 Not           Moderately        Very
                                               Satisfied        Satisfied       Satisfied
33. I compile relevant information
    needed to solve a problem.                    1        2       3        4      5

34. I formulate and carry out a
    solution.                                     1        2       3        4      5

35. I can handle several problems at
   one time.                                      1        2       3        4      5

36. I can work in a team to solve a
    problem successfully.                         1        2       3        4      5


Planning and organization skills

                                                 Not           Moderately        Very
                                               Satisfied        Satisfied       Satisfied
37. I set appropriate goals for myself
    (e.g., specific, realistic, measurable).      1        2       3        4      5

38. I develop strategies to meet my goals.        1        2       3        4      5

39. I prioritize tasks from most important
    to least important.                           1        2       3        4      5

40. I manage my time effectively.                 1        2       3        4      5

41. I meet deadlines and requirements.            1        2       3        4      5
Personal/professional balance

                                             Not           Moderately        Very
                                           Satisfied        Satisfied       Satisfied
42. I regularly participate in a
    balanced combination of work,
    school, and personal activities.            1      2       3        4      5

43. I can manage the stress that often
    occurs from participating in a
    variety of professional and
    personal activities.                        1      2       3        4      5

44. I maintain a high level of motivation
    for the activities in which I participate. 1       2       3        4      5

45. I maintain a high level of productivity
    in the activities in which I participate.   1      2       3        4      5

				
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